Tratamiento de las cefaleas en sala de emergencia pediatrica / Headache treatment in the pediatric emergency depart ment

Resumen Introducción : Las cefaleas son la segunda causa de consultas neurológicas en la sala de emergencia pediá trica. Muchos pacientes realizan varias visitas al año por este mismo problema, debemos conocer el tratamiento basado en evidencia. Métodos : Se realizó una búsqueda de publicaciones realizadas en los últimos 5 años en diferentes bases de datos. Discusión : Se presentan recursos para investigar sistemáticamente signos de alarma, recomendaciones para el uso racional de estudio de imágenes. Las cefaleas primarias son causa frecuente de consulta en la sala de emergencia. Se presenta tratamiento que cumple el res paldo científico para su utilización en pacientes con ce faleas primarias de tipo migraña en sala de emergencia.

Abstract Introduction : Headache is the second most frequent cause of neurological consultations in the pediatric emergency department. Patients become frequent visi tors per year due to headaches, evidence-based treat ment should be used. Methods : A search of publications within the last 5 years was conducted in different databases. Discussion : Strategies for a systematic approach in the evaluation of red flags, and recommendations for a rational use in neuroimaging studies are presented. Primary headaches are frequently seen in the emergency department. Migraine evidence-based treatment in the emergency department is reviewed.

Factores predictores de uso de drogas ilegales en personas atendidas en una sala de emergencia / Predictor factors of illegal drug use in subjects attended in an emergency room

Objetivo: Valorar el consumo reciente de alcohol y otras variables como predictores del uso reciente y consumo de vida de alguna droga ilegal, entre personas atendidas en una sala de emergencia (SE) de un hospital de Lima. Materiales y Métodos: Este estudio es un análisis secundario de datos de un trabajo previo observacional de corte transversal realizado por Mazzotti et al. (2005), cuya muestra estuvo constituida por 371 pacientes, que involucraron a todos los que fueron atendidos en la SE (Medicina y Cirugía) del Hospital Nacional Cayetano Heredia durante siete días completos de enero del año 2005. Se aplicó la encuesta del Sistema Interamericano de Datos sobre el Uso de Drogas (SIDUC) desarrollada por la Comisión Interamericana para el Control del Abuso de Drogas (CICAD) para uso reciente de sustancias psicoactivas. Resultados: El consumo reciente de alguna droga ilegal estuvo fuertemente asociado con el consumo reciente de alcohol (OR=32,21; IC 95%=9,0-114,5; p<0,001) y el sexo masculino (OR=4,52; IC 95%=1,2-15,8; p=0,018), lo cual se mantuvo aún después de ajustar por posibles variables de confusión. Asimismo, estas variables (consumo reciente de alcohol y sexo) mostraron asociación significativa con el consumo de vida de marihuana y cocaína. Conclusiones: El consumo reciente de alcohol y el sexo predicen fuertemente tanto uso reciente como uso de vida de alguna droga ilegal en el contexto de una SE, por lo que estas características pueden ser utilizadas para estrategias de tamizaje dirigidas a la intervención y manejo de problemas de drogas a nivel de servicios hospitalarios.

Objective: To assess recent alcohol consumption and other variables as predictors of recent use and lifetime use of illegal drugs among people visiting an emergency room in a hospital in Lima. Materials and Methods: This study is a secondary analysis of data from a previous study by Mazzotti et al. (2005). It had a cross-sectional observational design, and the sample consisted of 371 patients, involving all patients who were treated in the emergency room (Medicine and Surgery) of the Hospital Nacional Cayetano Heredia for seven full days in January 2005. The Inter-American System of Uniform Drug-Use Data (SIDUC) survey developed by the Inter-American Drug Abuse Control Commission (CICAD) was applied for recent use of psychoactive substances in emergency rooms. Results: We found strong association between recent use of any illegal drugs and both having recent alcohol use (OR=32.21;95% CI=9.0-114.5; p<0.001) and being a male (OR=4.52; 95% CI=1.2-15.8; p=0.018). These associations were kept even after adjustment for meaningful covariates. In addition, these characteristics (recent alcohol consumption and male) showed significant association with lifetime use of marijuana and cocaine. Conclusions: Recent alcohol use and sex were strong predictors of both recent and lifetime use of illegal drugs. Therefore, these individual-level features can be used in hospital-based screening strategies aimed to identify drug-related problems and provide timely help.

Consumo de alcohol en la consulta de una sala de emergencia / Alcohol consumption in the emergency room

Se examinaron patrones de consumo de alcohol y alcoholemia en sala de emergencia del hospital público de referencia para traumatismos en la provincia de Jujuy aplicando el Instrumento de Evaluación para los Trastornos Debidos al Consumo de Alcohol, versión corta (AUDIT-C). Se entrevistaron pacientes durante las 24 horas de 4 días (N=500) y se obtuvieron muestras para prueba de alcoholemia en el 84%. El 37% presentaba consumo de riesgo (hombres 50% vs. mujeres 23%) y el 29% tenía síntomas de dependencia (hombres 48% vs. mujeres 11%). El 17% de los hombres y el 3% de las mujeres tenían un nivel de alcoholemia igual o mayor a 50 mg/dl. En modelos de regresión logística multivariados la razón de posibilidades para los hombres de ser consumidores de riesgo (OR ajustado 3.2; IC 95% 2.1-5.0), tener síntomas de dependencia (OR ajustado 7.5; IC 95% 4.4-12.7) o niveles elevados de alcoholemia (OR ajustado 8.0; IC 95% 2.2-28.8), fue mayor que para las mujeres. Para ingresos por accidentes, situaciones de violencia o uso de drogas, la razón de posibilidades de ser consumidores de riesgo (OR ajustado 2.4; IC 95% 1.5-3.9), presentar síntomas de dependencia (OR ajustado 2.0; IC 95% 1.2-3.3), o alcoholemia (OR ajustado 7.7; IC 95% 3.0-19.8) fue mayor comparados con ingresos por otras causas. El alcoholismo tiene un impacto significativo en la ocurrencia de lesiones e influye sobre la demanda de atención médica. La implementación de programas de prevención podría ser una herramienta efectiva para reducir el impacto negativo del alcoholismo.

We examined patterns of alcohol consumption and blood alcohol levels in emergency room patients. The study was conducted in a public hospital of the province of Jujuy, Argentina. A survey was conducted among all patients during the 24 hours of 4 consecutive days (N=500) using the Alcohol Use Disorders Identification Test, short version (AUDIT-C). Blood samples were collected in 84% of participants. Results showed that 37% were hazardous drinkers (men 50% vs. women 23%), 29% had symptoms of dependence (men 48% vs. women 11%); 17% of men and 3% of women had high blood alcohol levels, equal or greater than 50 mg/dl. In multivariate logistic regression models men had increased likelihood of hazardous drinking (Adjusted OR 3.2; 95% CI 2.1-5.0), symptoms of dependence (Adjusted OR 7.5; 95% CI 4.4-12.7) and increased blood alcohol levels (Adjusted OR 8.0; 95% CI 2.2-28.8), compared with women. Patients admitted due to accidents, violence, or drug use, had increased likelihood of hazardous drinking (Adjusted OR 2.4; 95% CI 1.5-3.9), dependence symptoms (Adjusted OR 2.0; 95% CI 1.2-3.3) and increased blood alcohol levels (Adjusted OR 7.7; 95% CI 3.0-19.8), compared with those admitted for other reasons. Alcoholism has a significant impact on the occurrence of injuries and on the demand imposed on health services. Prevention programs can potentially reduce the negative health and social impact of alcoholism.

Impacto da campanha nacional do desarmamento no número de atendimentos por arma de fogo em serviço de emergência de cidade da região metropolitana de Porto Alegre, Brasil / Impact of the national disarmament campaignin the number of patient admissions due tofirearm injury in the emergency room of a citypart of Porto Alegre’s metropolitan region, Brazil

Investigar o impacto da Campanha Nacional do Desarmamento no número de atendimentospor ferimento por arma de fogo (FAF) em serviço de emergência de cidade da região sul doBrasil e o perfil dos pacientes. Métodos: Estudo de incidências do tipo antes-depois realizadocom todos pacientes atendidos na sala de emergência adulto do Hospital Nossa Senhora dasGraças (HNSG) entre outubro de 2003 e outubro de 2005. Resultados: Foram atendidos 418pacientes por FAF. A média de idade dos pacientes atendidos foi de 27,8 anos. Dos 418 pacientesatendidos, 108 (29%) foram encaminhados ao bloco cirúrgico. A freqüência de atendimentospor arma de fogo no período da noite (19 às 7 horas) foi 2,65 vezes maior do que o períododo dia. Os dias da semana que apresentaram maior número de atendimentos foram o sábado eo domingo, com 23% e 21%, respectivamente. A média mensal de atendimentos antes daCampanha foi de 14,8 e durante foi de 18,4 (p = 0,065). Conclusão: Não foi possível encontraruma redução no número de atendimentos por FAF na sala de emergência adulto do HNSGdevido à Campanha Nacional do Desarmamento.

To investigate the impact of The National Disarmament Campaign in the number of patientadmissions in an emergency room (ER) located in a southern-Brazil city due to firearminjury (FI) and to determine the characteristics of the patients. Methods: Incidence study(before-after study) with the mensal frequency of admissions due to FI from October 2003 toOctober 2005. Results: 418 patients were attended due to firearm injury. The mean age was27,8 years. 108(29%) patients left the ER directly to surgery. The frequency of admissions was2,65 higher at night (19 to 7 A.M). Saturday (23%) and Sunday (21%) were the days of theweek with more admissions. Before the Campaign the monthly average of admissions was 14,8and during the Campaign it was 18,4 (p=0,065). Conclusions: It was not possible to find areduction in the number of admissions due to firearm injury in the adult Nossa Senhora dasGraças Hospital’s ER as a result of the National Disarmament Campaign.