Quality statement 1: Assessment at diagnosis | Atopic eczema in under 12s | Quality standards

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

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

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: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from written clinical protocols.

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: No routinely collected national data for this measure has been identified. Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

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.

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 under 12s: diagnosis and management. NICE guideline CG57 (2007, updated 2023), recommendations 1.1.1.1 and 1.4.1.1

Definitions of terms used in this quality statement

Clinical and treatment histories

Healthcare practitioners should take detailed clinical and treatment histories at diagnosis to aid management of atopic eczema in children, and 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.

[Adapted from NICE's guideline on atopic eczema in under 12s, recommendation 1.1.1.1]

Potential trigger factors

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. [Adapted from NICE's guideline on atopic eczema in under 12s, recommendation 1.4.1.1 and expert opinion]