Clinical outcomes are broadly agreed, measurable changes in health or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice.
About the Dermatology service
The Dermatology department at Great Ormond Street Hospital (GOSH) offers a broad range of services for paediatric patients with severe and/or complex disorders that impact on the skin, including a wide range of genetic disorders, birthmarks, complex vascular malformations, severe eczema, severe psoriasis, morphoea, epidermolysis bullosa, and haemangiomas.
The Dermatology department sees around 4,300 children each year as outpatients. Last year, we cared for about 600 children as inpatients and 880 as day patients.
Our aim is to provide an environment of clinical excellence in the diagnosis and care of children with skin diseases and to support research into their causes and treatment. Members of the multi-disciplinary team include dermatologists, nurses, occupational therapists, a psychosocial team, interventional radiologists, and physiotherapists.
Clinical outcome measures
1. Outcomes for laser treatment of capillary malformations (‘port wine stains’)
Establishing outcome measures for laser treatment is complex and inexact. The challenge is that what we are measuring can be influenced by a number of factors including variation in the site, vessel size and depth of the malformation, skin colour and age of the child, the ambient temperature on the day and whether the child has just engaged in activity. The variation in the laser settings based on the type of treatment will also have an impact. Internationally, the field of laser surgery does not yet have a reliable means of accounting for these differences when analysing the data. However, we agree that it is important to measure our outcomes now as best as we can.
From April to August 2014, we asked parents/carers of children who had received a course of four treatments by our laser service to complete a Patient-Reported Outcome Measure (PROM). The PROM asked their opinion about the effect our laser treatment had on the appearance of their child’s port wine stain. Fifty nine PROMs were returned, showing the following results:
Results of the visual analogue scale from 59 patients who had recently completed a course of four laser treatments, where 1 indicates very unsatisfied and 10 indicates very satisfied with effectiveness of treatment in improving appearance of capillary malformation:
Laser treatment does carry a risk of adverse effects such as blisters, hyperpigmentation (darkening of the area of skin being treated) and scarring or swelling, particularly when higher energies are used. Our dermatologists who perform laser surgery recorded the incidence of adverse effects, capturing data for 68 patients in the collection period.
The figures showed that 91 per cent (N=68) of patients experienced no adverse effects from their laser treatment. Two patients (three per cent) experienced a blister shortly after treatment. In both cases, this was treated with antibacterial ointment and settled in a few days without scarring. Two patients (three per cent) reported swelling around the eye, an expected effect from the treatment, which settled within a day or two. One patient reported a scar after laser treatment, but this was not evident on clinical examination three months later. Another patient with dark brown skin developed an area of deeper brown after treatment on the neck, which resolved after six months.