WHAT'S COMING THROUGH THE FRONT DOOR? PAEDIATRIC AND ADOLESCENT GYNAECOLOGY IN THE EMERGENCY DEPARTMENT

Objectives & Background Paediatric gynaecology can provide challenging and varied consultations in the emergency department setting. Although the first international journal and society were established in the late 19809s, no specific UK guidelines have been published for the care of children and teenagers in this specialty. Moreover, limited published data is available regarding the types of cases presenting at the “front door”. This study aimed to investigate the scope of paediatric and adolescent gynaecological problems presenting to the emergency department of a UK children9s hospital. Methods A retrospective review of all gynaecological emergency department presentations at Birmingham Children9s Hospital from 1 st December 2012 to 30 th November 2013. Results The casualty cards for seventy patients were reviewed individually with ages ranging from 4 days to 15 years old. A spectrum of 16 different diagnoses was found, with the majority relating to vulvovaginitis (46%) and menstrual disorders (20%). The most common presenting complaints were equally divided between vaginal bleeding (21%) and vaginal pain (21%). Patients were mainly treated medically (40%), whereas nearly a third received advice (30%) and a quarter did not receive any treatment (26%). Over 95% of cases were discharged home from the emergency department; the majority of those (63%) needing further follow-up. Conclusion The study demonstrates the wide variety of paediatric gynaecology cases that present to the emergency department, nearly two thirds of which require ongoing care. This exhibits a need for both national guidance and appropriate training for front line medical staff covering the common gynaecological problems found in children.