Endocrine Abstracts

Introduction: Management of paediatric cortisol deficiency requires regular parent and child education and effective liaison with the emergency services. Best practice in the management of these patients is largely based upon local consensus. An annual steroid review service was introduced by the CNS team to provide education and improve parental understanding of the issues regarding cortisol deficiency in children. Emergency alert systems for the local children’s emergency department (CED) and ambulance services were also introduced. The aim of this project was to evaluate the success of these changes in improving the safety of patients with cortisol deficiency at one centre.

Methods: Audit criteria were agreed based upon local consensus standards and expert committee reports.

All 91 patients receiving steroid replacement for cortisol deficiency attending paediatric endocrine clinic during June 2014- June 2015 were included. A service evaluation was also conducted in the form of a structured parental questionnaire.

Results: 72.2% of patients had received an annual steroid review. 89% of questionnaire participants rated their experience of the annual steroid review as ‘excellent’ or ‘good.’ 100% of parents answered ‘strongly agree’ or ‘agree’ when asked if they understood their child’s condition. 60.2% and 81.8% of patients had an active alert in place for the CED and ambulance service respectively.

Conclusion: Parental feedback of the annual steroid review was very positive, with improved parental education and confidence in managing their child’s condition. Implementation of the ambulance alert system was largely successful, although administration must be improved to achieve universal coverage. The CED alert system should enable safe and effective emergency treatment of cortisol deficient patients. However, the current system did not identify all patients or specify ‘cortisol deficiency’ as required to ensure appropriate triage and management. This will be addressed with the CED and re-audited.