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 in an emergency: asthma, diabetes and epilepsy.
For more detailed analysis, read the recent report, Admissions of inequality: emergency hospital use for children and young people.
Between 2008/09 and 2017/18, the rate of emergency admissions for asthma in children and young people aged 0 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 186 per 100,000 population. This reduction of 53% 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.
In 2017/18, the rate of emergency admissions for asthma in children aged 5 to 9 was over 1.5 times as high as the rate in children aged 10 to 14, and 2.5 times as high as the rate in young people aged 15 to 24.
The rates of emergency admissions for type 1 diabetes have been stable or have decreased for younger children aged 0 to 14. However, there has been a striking increase in emergency admissions for diabetes in young adults aged 20 to 24. For 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.
Overall, emergency admissions for epilepsy have reduced over time for children and young people. Children aged 0 to 4 have the highest emergency admission rate for epilepsy, at 88 per 100,000 population in 2017/18. Emergency admission rates across the older age bands are lower. The improvement may be related to initiatives such as the 'Epilepsy 12' national audit and the introduction of new national best practice tariffs.
About this data
These indicators use data from Hospital Episode Statistics (HES) and the Office for National Statistics (ONS). They were calculated as follows:
Numerator: Emergency hospital admissions of children and young people aged 0-24 years with primary diagnosis of asthma, type 1 diabetes or epilepsy.
The ICD-10 codes used were:
- Asthma (J45: Asthma or J46: Status asthmaticus)
- Type 1 diabetes (E10: Insulin-dependent diabetes mellitus)
- Epilepsy (G40: Epilepsy or G41: Status epilepticus)
Denominator: Mid-year population estimate for England of the relevant age group.
Methodology: Crude rate per 100,000 population.
These indicators are loosely based on the 2.3.ii NHS Outcomes Framework indicator: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s. QualityWatch extended this indicator to look at emergency admissions for these conditions in children and young people aged 0 to 24, with an increased number of age categories.