Emergency admissions for children with chronic conditions

Background

Providing timely and effective primary and community care for selected long-term conditions (known as ambulatory care sensitive conditions) can help reduce avoidable emergency admissions to hospital. This applies to children and young people as well as adults. Here we look at three long-term conditions that children are most commonly admitted to hospital with as an emergency: asthma, diabetes and epilepsy.

For more detailed analysis, read the report, Admissions of inequality: emergency hospital use for children and young people.

Emergency admissions related to asthma are largely preventable with improved management and early intervention. Between 2008/09 and 2019/20, the rate of emergency admissions for asthma in children and young people aged 5 to 19 remained relatively constant. But the rate in children aged 0 to 4 years decreased from 399 emergency admissions per 100,000 population to 148 per 100,000 population. This reduction of 63% could be largely due to improved coding of asthma in young children by clinicians. Studies reported that childhood asthma was being overdiagnosed in primary care. As a result, clinicians were encouraged to use symptom diagnosis as a better option until diagnosis of asthma could be established using lung function tests.

Provisional data for 2020/21 shows that emergency admissions for asthma roughly halved in all age groups. The largest decrease was among those aged 0 to 4, falling from 148 emergency admissions per 100,000 population in 2019/20 to 58 per 100,000 population in 2020/21. This came alongside an overall decrease in emergency admissions during the coronavirus (Covid-19) pandemic. Research has found improvements in disease control among children with asthma during the pandemic, which may be due to reduced exposure to common asthma triggers during national lockdowns, such as air pollution and outdoor allergens.

In 2020/21, the rate of emergency admissions for asthma in children aged 5 to 9 was 1.8 times as high as the rate in children aged 10 to 14, and over 2.5 times as high as the rate in young people aged 15 to 19.

Between 2008/09 and 2019/20, the rates of emergency admissions for Type 1 diabetes remained stable or decreased for children and young people aged 0 to 19. However, there was a striking increase in emergency admissions for diabetes in young adults aged 20 to 24, from 66 emergency admissions per 100,000 population in 2008/09 to 94 per 100,000 population in 2019/20. In this age group, young people with diabetes transition from paediatric to adult services. The worsening trend is likely to be explained by fragmented and variable service quality, putting young people at risk of poorer control of diabetes and its symptoms.

In 2020/21, provisional data shows that emergency admissions for Type 1 diabetes fell by 24% for young people aged 15 to 19 and 26% for those aged 20 to 24 compared to 2019/20. Studies carried out during the pandemic reported an improvement in diabetes control in children and young people (excluding newly-diagnosed patients) in England after the first national lockdown began, which may be due to increased supervision from parents during lockdowns or public messaging about the increased risk of mortality from Covid-19 in people with diabetes. Rates of emergency admissions for children aged 0 to 14 remained roughly constant.

Overall, emergency admissions for epilepsy remained relatively constant between 2008/09 and 2019/20. In 2020/21, alongside an overall fall in emergency admissions during the Covid-19 pandemic, emergency admissions for epilepsy fell for all age groups. The largest decrease was in children aged 0 to 4 (a 19% decrease compared to 2019/20). Studies reported a decrease in children presenting at emergency department for seizure-related reasons during the pandemic, but the reasons for this are unclear. 

Children aged 0 to 4 have the highest emergency admission rate for epilepsy, at 83 admissions per 100,000 population in 2020/21. Emergency admission rates across the older age bands are lower.