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BackgroundUnscheduled visits to emergency departments (ED) have increased in the UK in recent years. Children who are repeat attenders are relatively understudied.AimsTo describe the sociodemographic and clinical characteristics of preschoolers who attend ED a large District General Hospital.Method/study designObservational study analysing routinely collected ED operational data. Children attending four or more visits per year were considered as ‘frequent attenders’. Poisson regression was used with demographic details (age, sex, ethnicity, sociodemographic status) to predict number of attendances seen in the year. We further analysed detailed diagnostic characteristics of a random sample of 10% of attendees.Main findings10 169 patients visited in the 12-month period with 16 603 attendances. 655 individuals attended on 3335 occasions. 6.4% of this population accounted for 20.1% of total visits. In the 10% sample, there were 304 attendances, and 69 (23%) had an underlying chronic long-standing illness (CLSI). This group were 2.4 times more likely to be admitted as inpatients compared with those without such conditions, median length of stay of 6.2 hours versus 2.5 hours (p=NS).ConclusionsFrequent ED attenders fall broadly into two distinct clinical groups: those who habitually return with self-limiting conditions and those with or without exacerbation of underlying CLSI. Both groups may be amenable to both additional nursing and other forms of community support to enhance self-care and continuity of care. Further research is required to increase our understanding of specific individual family and health system factors that predict repeat attendance in this age group.

Aims To establish trends in diagnoses in pre-school children admitted to a large urban hospital over a 10 year period with respiratory symptoms. To explore the feasibility of developing a baseline for time trend analysis with the objective of assessing the effects of service innovations designed to improve quality of care for children with asthma and allergy. Methods We analysed routine data in-patient attendances to the hospital between 2004 and 2013. We included all children under 5 years old where there was coding of diagnosis on discharge. Descriptive analysis of the top 5 diagnoses over 10 years. Results There were 12,601 admissions of children under 5 years old in the study period which accounted for 60.5% of the total admissions of children under 15 years old. Acute upper respiratory infection, acute bronchiolitis, and asthma were consistently the top 3 diagnoses in 9 out of the 10 years in this age group; over half of the diagnoses (mean 51.2%, sd 7.9, [40.3–63.3%]). Acute upper respiratory infection was the leading diagnosis in 8 out of the 10 years and ranged from 41.6% (2004) to 13.1% (2013). There was a relative reduction in the proportion of children diagnosed with URTis over this time with an increase in other categories (Figure 1). The majority of admissions were less than 1.6 days. Conclusion Acute respiratory infection has been consistently the main primary diagnosis of pre-school children admitted on to our wards. The increase in “asthma” might suggest possible systematic diagnostic coding differences during this time period or a true increase in prevalence in this age group as has been described 1 . Accurate baseline data is essential especially for this age group where a diagnosis of asthma may vary considerably between practitioners and over time. Adherence to recent guidelines on accurate diagnosis in preschoolers 2 and appropriate staff training of clinicians and clinical coders may help to refine this further. References Radhakrishnan D, Dell S, Guttmann A, Shariff S, Liu K, To T. Trends in the age of diagnosis of childhood asthma. J Allergy Clin Immunol 2014; 134(5):1057–62.e5 Saglani S, Bush A. Asthma in preschool children: the next challenge. Curr Opin Allergy Clin Immunol 2009; 9:141–5

Background Unscheduled attendances are increasing annually in preschool children under 5 years of age in England. Despite research in adult settings on recurrent attenders, there is limited UK data in pre-schoolers. Nationally, this is one of the largest population groups attending emergency and urgent care facilities. Further characterisation of socio-demographic, GP and clinical characteristics may identify a potential group suitable for intervention. We hypothesised that small and very; arge practices might have increased risk of PRA. Aims To describe the socio-demographic and general practice factors of under-5 patients who attend an A&E and/or UCC in a large metropolitan DGH. Which socio-demographic factors are predictive of being a paediatric recurrent attender ( PRA ) presenting with ≥4 ED visits? Does GP practice size have an influence on ED use? Methods Retrospective study using a dataset of emergency attendances from 01 October 2013 to 30 September 2014. PRA is defined as a child younger than 5, with ≥4 unscheduled ED visits during the year. Descriptive statistics, univariate analyses and logistic regression techniques were used to analyse the characteristics of the study population. Deprivation measures included IMD and IDACI. Stata software was used to analyse the data. Results During the study period, there were 16,220 attendances by 9770 individual patients. 7.8% of patients accounted for 20.7% of visits. The distribution is shown in Table 1. The following factors were found to be significantly predictive (p Limitations include suboptimal clinical coding and lack of data on GP: child patient ratios. Conclusion This is the first study to combine both A and E and UCC data in a single locality. Children under five who attend 4 or more times in a year are more likely to be Asian infants from medium deprivation households, with a respiratory illness and attending out of hours. Clinical characterisation from more detailed notes review aims to identify those who might benefit from specialist community nursing support and educational intervention. We are currently interviewing parents in these groups to better understand motivations for attendance.