Paediatric admissions

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Paediatric patients who require admission to hospital may be at risk of deterioration on the journey and consideration needs to be given to the mode of transfer - ambulance or taken by parents by car.

There are no clear criteria to make that decision and it should be made by the referring clinician with input, if required from the receiving clinician.

The NICE traffic light tool can be helpful but is hugely over-sensitive if used rigidly2

PEWS score is not validated for pre-hospital assessment1 but the process of calculating the score can be helpful in flagging abnormal observations.

In particular SpO2 is helpful in assessment of children with respiratory disease. Documented low SpO2 is likely to mandate ambulance transfer.

Normal paediatric vital signs

Age
Heart rate (bpm)
Respiratory rate (/min)
Systolic blood pressure (mmHg)
0 - 11 months
110-159
 30-49 70-99
12 - 23 months
 100-149
25-39
 70-99
2 - 4 years
 90-139
20-34
 80-99
5 - 11 years
 80-129
20-29
70-109
Over 12 years
70-109
15-24
 95-140

SpO2 < 94% is abnormal in PEWS score

Primary care assessment

It is helpful to assess and document:

  • Heart rate
  • Respiratory rate
  • Capillary refill time
  • SpO2
  • General behaviour - irritable/drowsy/floppy/alert

Admission process

To arrange admission call paediatric receiving at DGRI switchboard

Discuss with on-call paediatrician

Advise the parents to take the child direct to paediatrics, not via emergency department

If admitting via ambulance, paramedics will take the child to the ward or to resus in ED depending on their presentation.

Note that both medical and surgical (including urology) assessments are arranged via paediatric receiving.

References

1. Corfield, Alasdair R.a; Booth, Katherine L.a; Clerihew, Lindab; Staines, Harryc; Stewart, Elained; Rooney, Kevin D.e. Association of out of hospital paediatric early warning score with need for hospital admission in a Scottish emergency ambulance population. European Journal of Emergency Medicine 27(6):p 454-460, December 2020. | DOI: 10.1097/MEJ.0000000000000725 

2. Amy Clark, Rebecca Cannings-John, Megan Blyth, Alastair D Hay, Christopher C Butler, Kathryn Hughes Accuracy of the NICE traffic light system in children presenting to general practice: a retrospective cohort study. British Journal of General Practice 2022; 72 (719): e398-e404. DOI: 10.3399/BJGP.2021.0633

https://bjgp.org/content/72/719/e398

Editorial Information

Last reviewed: 20/11/2023

Next review date: 20/11/2025

Version: 1.0

Reviewer name(s): Fergus Donachie, Andrew McIntyre.