A cohort of 5,243 live newborn infants in Haifa was followed to determine hospital admissions during the first two years of life. Parameters of the family and the neonate, routinely available at birth, were collected and studied in order to select those which would identify co-host infants with an increased risk of hospitalization during infancy. A total of 767 cohort children (14.6%) were admitted to hospital. Multivariate analysis showed that many group factors are interrelated and therefore inconsistent. Six single independent factors predisposing to hospital admission could be defined (in order of decreasing significance): increasing birth order, male sex, poor education (up to four years of schooling), birth weight less than 2,250 gm, Jewish mothers born in Asia or Africa, and maternal age up to 24 years. Numerical risk coefficients allocated to each of the above six single (multivariate) factors enabled the calculation of a predicted risk coefficient scoring the risk of admission to hospital. The use of a score predicted 43.3% of the total initial hospitalizations affecting 23.3% of the total cohort. The allocation of health resources might be improved by the use of such a method of scoring to select families in need of special services.

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AimsAnalysis of the demographics, patterns of presentation and outcomes of all children <1yr old presenting with injuries to 9 Emergency departments in one health board over a 3 month period, with critical analysis of those requiring full child protection investigation.MethodsThe Health Board has 9 Emergency departments, and in a 3 month period in 2014, 2531 children attended. A protocol for ‘Recognition and management of maltreatment in infants’ exists, and 388 infants met the inclusion criteria of presentation with injury. Case records for 375 children were able to be analysed for demographics; previous attendances; nature of injury; environmental risk factors for NAI; investigations; and follow up where welfare concerns were identified.Abstract G304(P) Figure 1In cases where injury were found the majority of infants, (59%) presented with head injury. Burns (9%) and lacerations (6%) were next most prevalentAbstract G304(P) Figure 2Accidental injury was the concluding diagnosis in 97%. 11 (2.9%) children fulfilled the protocol criteria for full child protection investigations consisting of skeletal survey, intracranial imaging, ophthalmology review and bloods. All 11 were admitted to the ward for investigation where the mean length of stay was 4.5 daysResults375 children <1 yrs presented with injuries, 42.6% female, 56.8% male. Age at attendance rose from 1.9% <1 month to a peak of 17.3% at 11 months.Of these 11 infants, the conclusion was that 4 were accidental injury, 4 remained unexplained and 3 were NAI.Abstract G304(P) Table 1ConclusionWe describe the presentation of injuries in a large group of children under the age of 1, of whom 2.9% fulfilled the criteria for full child protection investigation. Only 7 (1.8%) were deemed to have NAI or unexplained injury. The majority had a multi-agency child protection case conference with safeguarding plans agreed prior to discharge, following which all were returned to parental care or kinship care.

AimsA large multi hospital audit across Greater Glasgow and Clyde of compliance with the protocol ‘Recognition and management of maltreatment in infants’ had demonstrated that history taking, examination and note keeping was often inadequate. A proforma was introduced to be used in all children under the age of one year presenting with an injury. A second audit was carried out to see what the impact of this proforma was.MethodsA protocol has been implemented in Greater Glasgow and Clyde to be followed in all children under the age of one presenting to emergency departments where there is concern about welfare and protection. A multi hospital audit was carried out to evaluate the compliance with this protocol. In the first audit cycle 272 sets of emergency department records were audited, of children that had presented to emergency departments in August, September and October of 2012, findings were noted on detail of history taking, documented examination and note keeping. Areas for improvement were highlighted following the first round of the audit and a new under 1’s injury proforma was introduced by emergency medicine. This proforma is used to assess all children under the age of one year who attend an emergency department with an injury. A second audit cycle was completed in August, September and October of 2014 looking at 375 sets of emergency department notes.ResultsAbstract G244(P) Table 1History TakingAudit 1Audit 2Was a full history taken?Yes 35%No 65%Yes 79.7%No 20.3%Was mechanism o finjury detailedYes 86%No 14%Yes 94%No 6%Abstract G244(P) Table 2ExaminationAudit 1Audit 2Was a full examination done?Yes 29%No 70%NR 1%Yes 79%No 20%NR 1%Was there documentaion of examination for other injuries?Yes 29%No 71%Yes 81%No 19%ConclusionsIntroduction of a proforma improved history taking, examination and notekeeping in children under the age of one year of age presenting to emergency departments in Greater Glasgow and Clyde.