M27 Wheezes, coughs and splutters: how do paediatric trainees manage them?

Abstract

Introduction and objectives Wheezy pre-school children frequently present to paediatric departments. There is a wide variation in how paediatric trainees investigate and manage these children, which can be associated with unnecessary costs to the NHS. Our aim was to assess this diversity in management options initiated by paediatric trainees. Methods Web-based survey on how paediatric trainees approach scenarios of wheezy pre-school children. Trainees across the UK were asked to fill in a questionnaire consisting of four case scenarios involving wheezy children under the age of 5. Results 194 trainees responded to the survey. There was a good representation amongst different training grades across UK deaneries. In the bronchiolitis scenario, 13% requested blood tests or a chest x-ray, whilst 27% of trainees stated they would not investigate further. Treatment options included oxygen, salbutamol, ipratropium, 0.9% saline drops or nebulisers, 3% saline nebulisers or not doing anything at all. It appears that trainees are less confident at differentiating episodic viral wheeze from multi-trigger wheeze. 49% of trainees stated they would be give prednisolone to children with a first episode of viral wheeze. Trainees used different cut-off levels of oxygen saturations to initiate oxygen therapy. 69% of trainees felt that recurrent episodes of multi-trigger wheeze warranted regular inhaled beclomethasone, whilst 15% felt that montelukast was more appropriate. The need for an asthma action plan and asthma clinic follow up was raised by 85% and 76% of trainees respectively. We sought to assess the knowledge of trainees on predisposing factors for early-onset multi-trigger wheeze. The two most predictive risk factors are a personal history of eczema, and a family history of asthma in mum or dad, which were identified by 78% and 59% of trainees respectively. Conclusions There is a marked variation in how paediatric trainees deal with childhood wheeze. Rationalising investigations and therapeutic measures in bronchiolitis is associated with cost savings. Commonly used steroids are well known to have sideeffects and should only be used where indicated. Local and national guidelines on childhood wheeze should aim to standardise practice across the UK for paediatric trainees, and reduce the financial burden on the NHS.