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J Paediatr Child Health. 2019 Jan 30. doi: 10.1111/jpc.14386. [Epub ahead of print]

Paediatric emergency department presentations due to feeding tube complications in children with cerebral palsy.

Author information

1
Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.
2
Developmental Disability and Rehabilitation Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
3
Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
4
Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
5
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
6
Department of Gastroenterology, Hepatology and Liver Transplant, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.

Abstract

AIM:

To describe the characteristics of emergency department (ED) presentations due to complications from gastrostomy or gastrojejunal feeding tubes among children with cerebral palsy (CP), the complexity of complications and the management approaches taken.

METHODS:

The Victorian CP Register was linked to the ED databases of Victoria's two tertiary paediatric hospitals, and data on presentations due to feeding tube complications were identified based on discharge diagnosis codes. Additional data on presentations were extracted from medical records.

RESULTS:

Over 5 years, there were 234 ED presentations due to feeding tube-related complaints among a CP cohort (n = 2183). ED notes were located for 183 of the 234 presentations. The majority of presentations (90%) involved children with severe gross motor impairment. A total of 46% of presentations (n = 84) was triaged as lower urgency, and 68% (n = 124) took place between 08:00 am and 06:00 pm. The most common presenting complaint was tube dislodgement (n = 105; 70%). No investigations were recorded in the majority of cases, and in almost 90% of cases, the feeding tube was successfully replaced in the ED, usually by an ED physician (n = 74) and less frequently by a surgeon (n = 9), gastroenterologist (n = 2) or nurse (n = 8); 9% (n = 17) resulted in a hospital admission.

CONCLUSIONS:

Most ED presentations due to feeding tube complaints in children with CP are in children with severe gross motor impairment but are able to be managed in the ED. As such, it is likely that care givers and other health professionals could manage some of the complications experienced in primary health-care settings closer to home.

KEYWORDS:

cerebral palsy; emergency department use; feeding tube

PMID:
30697863
DOI:
10.1111/jpc.14386

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