Quality statement 1: Assessment at diagnosis

Quality statement

Children with atopic eczema are offered, at diagnosis, an assessment that includes recording of their detailed clinical and treatment histories and identification of potential trigger factors.

Rationale

Recording a child's detailed clinical and treatment history as part of the assessment in all healthcare settings is an important step in the management of atopic eczema in children. At the diagnosis stage, assessing potential trigger factors, including irritants and allergens, will lead to better management and potentially lead to a reduction in the severity of the atopic eczema experienced by the child.

Quality measures

Structure

Evidence of local arrangements to ensure that children with atopic eczema are offered, at diagnosis, an assessment that includes recording of their detailed clinical and treatment histories and identification of potential trigger factors.

Data source: Local data collection.

Process

The proportion of children with atopic eczema who receive, at diagnosis, an assessment that includes recording of their detailed clinical and treatment histories and identification of potential trigger factors.

Numerator – the number of children in the denominator who receive, at diagnosis, an assessment that includes recording of their detailed clinical and treatment histories and identification of potential trigger factors.

Denominator – the number of children with newly diagnosed atopic eczema.

Data source: Local data collection.

What the quality statement means for service providers, healthcare practitioners and commissioners

Service providers ensure that systems are in place to offer children with atopic eczema, at diagnosis, an assessment that includes recording of their detailed clinical and treatment histories and identification of potential trigger factors.

Healthcare practitioners offer children with atopic eczema, at diagnosis, an assessment that includes recording of their detailed clinical and treatment histories and identification of potential trigger factors.

Commissioners ensure that they commission services with local arrangements to offer children with atopic eczema, at diagnosis, an assessment that includes recording of their detailed clinical and treatment histories and identification of potential trigger factors.

What the quality statement means for patients and carers

Children with newly diagnosed atopic eczema are offered an assessment, in which their healthcare professional records their detailed medical and treatment histories and identifies any factors that might trigger their eczema.

Source guidance

  • Atopic eczema in children (NICE clinical guideline 57), recommendations 1.1.1.1 and 1.4.1.1 (key priority for implementation).

Definitions of terms used in this quality statement

Clinical and treatment histories

NICE clinical guideline 57 recommends that healthcare practitioners take detailed clinical and treatment histories at diagnosis to aid management of atopic eczema in children, and that these should include questions about:

  • time of onset, pattern and severity of the atopic eczema

  • response to previous and current treatments

  • possible trigger factors (irritant and allergic)

  • the impact of the atopic eczema on children and their parents or carers and families

  • dietary history including any dietary manipulation

  • growth and development

  • personal and family history of atopic diseases.

Potential trigger factors

NICE clinical guideline 57 recommends that when clinically assessing children with atopic eczema, healthcare practitioners should seek to identify potential trigger factors including irritants, for example soaps and detergents, skin infections and contact, food and inhalant allergens. In addition, the expert opinion of the Topic Expert Group stated that psychological stress can cause flares of atopic eczema, and should be avoided where possible.