ABSTRACT
OBJECTIVE: The objective of the study is to evaluate the usefulness of the leukocyte (white blood count [WBC]) and neutrophil (absolute neutrophil count [ANC]) counts; the values of C-reactive protein (CRP), procalcitonin, and calprotectin (CP); and the APPY1 Test panel of biomarkers, to identify children with abdominal pain at low risk for appendicitis. METHOD: Children 2 to 14 years of age with abdominal pain suggesting acute appendicitis (AA) were prospectively included. Procalcitonin, calprotectin, C-reactive protein, white blood count, ANC, and the new plasma APPY1 Test were performed. The final diagnosis was determined by histopathology in cases of AA and telephone follow-up in children discharged without AA. RESULTS: Between February 2012 and June 2013, 185 children were enrolled with an average age of 9.32±2.7 years. Eighty-nine (48.1%) were finally diagnosed with AA. The APPY1 Test panel showed the highest discriminatory power, sensitivity of 97.8 (95% confidence interval [CI], 92.2-99.4), negative predictive value of 95.1 (95% CI, 83.9-98.7), negative likelihood ratio of 0.06 (95% CI, 0.01-0.22), and specificity of 40.6 (95% CI, 31.3-50.5). A negative APPY1 Test and ANC less than 7500 per milliliter provided a sensitivity of 100 (95% CI, 95.9-100), negative predictive value of 100 (95% CI, 89.8-100), and specificity of 35.4 (95% CI, 26.6-45.4). In the multivariate analysis, only the APPY1 Test and ANC greater than 7500 per milliliter were significant risk factors for AA (odds ratio, 13.76; 95% CI, 3.02-62.57, and odds ratio, 6.37; 95% CI, 2.89-14.28, respectively). CONCLUSIONS: The APPY1 Test panel with ANC could be useful in identifying children with abdominal pain suggestive of AA who are at low risk for this disease.
Subject(s)
Abdominal Pain/etiology , Appendicitis/diagnosis , Biomarkers/blood , Adolescent , Appendicitis/blood , Appendicitis/complications , C-Reactive Protein/metabolism , Calcitonin/blood , Calcitonin Gene-Related Peptide , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Leukocyte Count , Leukocyte L1 Antigen Complex/blood , Logistic Models , Male , Prospective Studies , Protein Precursors/blood , Sensitivity and SpecificityABSTRACT
Introducción: La prevención de las intoxicaciones agudas pediátricas requiere conocer las circunstancias en que suceden. Objetivos: Analizar las circunstancias de las intoxicaciones en<7 años de edad y su manejo en los Servicios de Urgencias Pediátricos hospitalarios en España (SUPE). Material y métodos: Estudio prospectivo incluyendo episodios de intoxicaciones en <7 años de edad registrados en 44 hospitales entre los años 2008 y 2011. Resultados: Se registraron 400 intoxicaciones, 308 (77%) en <7 años; 23 (7,5%) referían episodios similares previos familiares. Sucedieron en domicilio familiar 230, principalmente por ingesta no intencionada (89,6%) de medicamentos (182; 59%), productos del hogar (75; 24,4%) y cosméticos (18; 5,8%). El 36,6% contactó previamente con otros servicios. En el hospital recibieron tratamiento 160 (51,9%) y el 45,4% ingresó. Ninguno falleció. En las intoxicaciones por fármacos se practicaron más frecuentemente exploraciones complementarias (48,9% vs. 32% por productos del hogar y 11,1% por cosméticos; p<0,05), tratamientos (64,8% vs. 36% y 16,6%; p<0,0001) e ingreso (54,9% vs. 37,3% y 5,5%; p=0,015) y el 12,1% no fue por ingesta accidental (vs. 2,6% y 0%; p<0,05), sobre todo errores de dosificación. Las intoxicaciones por productos del hogar se asociaron más frecuentemente a conservación en envases no originales y al alcance de los niños. Conclusiones: La mayoría de las intoxicaciones atendidas en SUPE suceden en <7 años, tras ingesta no intencionada de fármacos y productos del hogar en el domicilio. Las intoxicaciones por fármacos fueron potencialmente más peligrosas. La prevención debiera considerar la educación sobre almacenaje de medicamentos/productos del hogar, administración de medicamentos y consejos para evitar nuevos episodios (AU)
Introduction: To prevent acute poisoning in children we need to know in which circumstances they occur. Objective: To analyse the circumstances of poisoning in children under 7 years-old and the management of these children in Spanish Paediatric Emergency Departments (SPED). Material and methods: We perform a prospective study of charts of poisoned children less than 7 years admitted to 44 hospitals between 2008 and 2011. Results: A total of 400 poisoned children were recorded: 308 (77%) in children under 7 years, of whom 23 (7.5%) of them had previous episodes of poisoning in the family. More than half (230) occurred at home, mainly due to accidental ingestion (89.6%), of drugs (182, 59%), household products (75, 24.4%), and cosmetics (18, 5.8%). More than one-third (36.6%) contacted other departments before the patient reached SPED. A total of 160 (51.9%) were treated in the hospital, and 45.4% were admitted in the hospital. None of them died. Drug poisoning required complementary tests more often (48.9% vs. 32% household products, and 11.1% cosmetics, P<.05), more treatments (64.8% vs. 36% and 16.6%, P<.0001) and more admissions (54.9% vs. 37.3% and 5.5%, P=.015), and 12.1% were not due to accidental ingestion but dosage errors (vs. 2.6% and 0%, P<.05).Household product poisonings were more often related with storage in non-original packaging and being reachable by children. Conclusions: The most frequent poisonings seen in SPED were caused by the accidental ingestion of drugs and household products by children less than 7 years-old at home. Drug poisoning was potentially more risky. Drug and household product storage education, proper drug dosage and administration, and good advice are the main issues to prevent these poisonings (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Poisoning/epidemiology , Emergency Treatment/methods , Accidents, Home/prevention & control , Prospective Studies , Emergency Medical Services/statistics & numerical dataABSTRACT
INTRODUCTION: To prevent acute poisoning in children we need to know in which circumstances they occur. OBJECTIVE: To analyse the circumstances of poisoning in children under 7 years-old and the management of these children in Spanish Paediatric Emergency Departments (SPED). MATERIAL AND METHODS: We perform a prospective study of charts of poisoned children less than 7 years admitted to 44 hospitals between 2008 and 2011. RESULTS: A total of 400 poisoned children were recorded: 308 (77%) in children under 7 years, of whom 23 (7.5%) of them had previous episodes of poisoning in the family. More than half (230) occurred at home, mainly due to accidental ingestion (89.6%), of drugs (182, 59%), household products (75, 24.4%), and cosmetics (18, 5.8%). More than one-third (36.6%) contacted other departments before the patient reached SPED. A total of 160 (51.9%) were treated in the hospital, and 45.4% were admitted in the hospital. None of them died. Drug poisoning required complementary tests more often (48.9% vs. 32% household products, and 11.1% cosmetics, P<.05), more treatments (64.8% vs. 36% and 16.6%, P<.0001) and more admissions (54.9% vs. 37.3% and 5.5%, P=.015), and 12.1% were not due to accidental ingestion but dosage errors (vs. 2.6% and 0%, P<.05). Household product poisonings were more often related with storage in non-original packaging and being reachable by children. CONCLUSIONS: The most frequent poisonings seen in SPED were caused by the accidental ingestion of drugs and household products by children less than 7 years-old at home. Drug poisoning was potentially more risky. Drug and household product storage education, proper drug dosage and administration, and good advice are the main issues to prevent these poisonings.
