¿Estamos preparados para una catástrofe? Estudio multicéntrico español / Are we prepared for a disaster? Spanish multicentre study

Introducción: Los servicios de urgencias pediátricos (SUP) deben tener planes de actuación ante una catástrofe, para poder actuar rápida y eficazmente. Objetivos: a) Conocer si los SUP españoles tienen planes de catástrofes; b) describir sus características, y c) si contemplan las necesidades pediátricas. Material y métodos: Estudio observacional descriptivo multicéntrico, mediante encuestas dirigidas a responsables de los SUP de España. Se incluyen preguntas sobre los planes de catástrofes externas (PCE) y sobre los planes de catástrofes internas (PCI). Resultados: De 44 encuestas enviadas, 25 hospitales responden. Dieciocho disponen de PCE, con una antigüedad de 10 años y que se revisa cada 3 años o más (9 hospitales), bienalmente (4) y anualmente (2). El PCE es conocido por el personal en 11/18 hospitales. En 13/18 hospitales nunca se realizan simulacros del PCE. Veintiún hospitales disponen de PCI, con una antigüedad de 8 años y frecuencia de revisión de cada 3 años o más (11), bienalmente (3) y anualmente (3). El PCI es conocido por el personal en 13/21 hospitales. Nunca se realizan simulacros del PCI en 12/21. Los PCI incluyen plan de evacuación (22), incendios (19), amenazas de bomba (13) e inundaciones (9). En 9 hospitales, los planes son pediátricos; en 7, son planes generales que contemplan las necesidades de los niños; el resto no tiene en cuenta a víctimas pediátricas. Conclusiones: La mayoría de SUP dispone de planes de catástrofes, pero estos están poco actualizados, son poco conocidos y la mitad no tiene en cuenta al paciente pediátrico. Es necesario mejorar los planes de catástrofe(AU)

Introduction: Paediatric Emergency Departments (PED) should have written disaster plans, to ensure a rapid and efficient response. Objectives: 1) to determine if Spanish PED have written disaster plans, 2) to describe the characteristics of these plans, and 3) if paediatric victims were included in them. Material and methods: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. The structured survey included questions about external emergency plans (EEP) and internal emergency plans (IEP). Results: Twenty-five out of 44 surveys were replied. Eighteen PED had an EEP, most of them had been written 10 years ago and were reviewed every 3 years or more. In 11/18 PED, the EEP was well-known by health care providers. Drills were never performed in 13/18 PED. Twenty-one PED had an IEP, most of them had been written 8 years ago and were reviewed every 3 years or more. In 13/21 PED, IEP was well-known by health care providers but drills were never performed in 12/21 PED. IEP included evacuation plans (22), fire emergency plans (19), bomb threat plan (13) and flood plans (9). Nine PED have paediatric-specific disaster plans and in 7 PED, disaster plans included adult and paediatric victims. Children were not included In 1 EEP and in 5 IEP. Conclusions: Most of PED have written disaster plans, but these plans are old, unknown by health care providers and almost half of them do not include paediatric victims. It is necessary to improve disaster planning in Spanish PED(AU)

[Are we prepared for a disaster? Spanish multicentre study]. / ¿Estamos preparados para una catástrofe? Estudio multicéntrico español.

INTRODUCTION: Paediatric Emergency Departments (PED) should have written disaster plans, to ensure a rapid and efficient response. OBJECTIVES: 1) to determine if Spanish PED have written disaster plans, 2) to describe the characteristics of these plans, and 3) if paediatric victims were included in them. MATERIAL AND METHODS: Descriptive multicentre study based on questionnaires sent to physicians in charge of different Spanish PED. The structured survey included questions about external emergency plans (EEP) and internal emergency plans (IEP). RESULTS: Twenty-five out of 44 surveys were replied. Eighteen PED had an EEP, most of them had been written 10 years ago and were reviewed every 3 years or more. In 11/18 PED, the EEP was well-known by health care providers. Drills were never performed in 13/18 PED. Twenty-one PED had an IEP, most of them had been written 8 years ago and were reviewed every 3 years or more. In 13/21 PED, IEP was well-known by health care providers but drills were never performed in 12/21 PED. IEP included evacuation plans (22), fire emergency plans (19), bomb threat plan (13) and flood plans (9). Nine PED have paediatric-specific disaster plans and in 7 PED, disaster plans included adult and paediatric victims. Children were not included In 1 EEP and in 5 IEP. CONCLUSIONS: Most of PED have written disaster plans, but these plans are old, unknown by health care providers and almost half of them do not include paediatric victims. It is necessary to improve disaster planning in Spanish PED.

Características clínicas de la gripe A H1N1 2009: estudio multicéntrico / Clinical features of influenza A H1N1 2009: a multicentre study

Objetivo: Describir las características clínico-epidemiológicas de los niños diagnosticados de gripe A H1N1 2009 en urgencias de 4 hospitales. Material y métodos: Estudio prospectivo multicéntrico de julio a diciembre 2009. Se incluyó a los pacientes diagnosticados de gripe A H1N1 2009 por PCR en tiempo real en urgencias. La solicitud de la prueba se hizo según los protocolos establecidos en cada momento de la epidemia. Se recogieron datos epidemiológicos, clínicos, de laboratorio y evolutivos. Resultados: Se incluyeron 456 casos con una mediana de edad de 6,5 años (PC25-75 3-10,6).Presentaron factores de riesgo para complicaciones de la gripe 266 pacientes (59,4%); principalmente complicaciones pulmonares (47%), cardiovasculares (17%), neurológicos (14%) e inmunodeficiencias (11%). La clínica más frecuente fue fiebre (96%), tos (88%), rinorrea (72%), mialgias o astenia y dificultad respiratoria y, menos frecuentes, síntomas digestivos y neurológicos. Se solicitó radiografía de tórax a 224 pacientes (49%), presentando un 31% infiltrados lobares y un 15% intersticiales. Ciento cuarenta pacientes fueron hospitalizados (31%), necesitando el apoyo de la unidad de cuidados intensivos (mediana de estancia 4 y 3,5 días, respectivamente).Las complicaciones más frecuentes fueron neumonías y crisis de broncospasmo. Fallecieron3 pacientes (un paciente previamente sano por miocarditis y 2 con encefalopatía por fallo respiratorio). Otro caso de miocarditis se recuperó con secuelas. Conclusiones: El perfil del paciente con gripe A H1N1 2009 diagnosticada en urgencias fue el de un escolar, con factores de riesgo de complicaciones, que presentaba sintomatología respiratoria febril de corta evolución al que pudo darse de alta. Además de las complicaciones respiratorias habituales de la gripe, destacaron los casos de afectación miocárdica (AU)

Objective: To describe clinical and epidemiological features of influenza A H1N1 2009 diagnosed patients in the Emergency Department of 4 hospitals. Material and methods: Prospective multicentre study conducted from july to december 2009. The patients diagnosed by Real-Time PCR of influenza A H1N1 2009 in the emergency department were included. The test was requested according to the protocols established throughout the epidemic. Epidemiological, clinical, laboratory variables and outcomes were evaluated. Results: A total of 456 cases were included, with a median age of 6.5 years (PC25-75 3-10.6). There were risk factors of complications In 266 patients (59.4%) due to the influenza, mainly: respiratory (47%), cardiovascular (17%), neurological (14%) and immunosuppression (11%). The most frequent symptoms were fever (96%), (88%) cough, (72%) rhinorrhoea, muscle aches orasthenia and breathing difficulties and, less common, gastrointestinal and neurological symptoms. Chest X-ray was performed on 224 cases (49%), with lobar (31%) and interstitial (15%) infiltrates. One hundred and forty patients (31%) were hospitalised and 3.2% required Intensive Care Unit (median stay 4 and 3.5 days, respectively). The most frequent complications were pneumonias and bronchospasms. Three patients died (a previously healthy patient with myocarditis and 2 patients with encephalopathy due to respiratory failure). Another case of myocarditis recovered with sequelae. Conclusions: The profile of patient with influenza A 2009 diagnosed in the emergency department was a school child, with risk factors of complications, presenting with respiratory symptoms and fever over a short time, and who can be discharged. It is important to emphasise myocarditis, as well as the usual respiratory complications of influenza virus (AU)

[Clinical features of influenza A H1N1 2009: a multicentre study]. / Características clínicas de la gripe A H1N1 2009: estudio multicéntrico.

OBJECTIVE: To describe clinical and epidemiological features of influenza A H1N1 2009 diagnosed patients in the Emergency Department of 4 hospitals. MATERIAL AND METHODS: Prospective multicentre study conducted from july to december 2009. The patients diagnosed by Real-Time PCR of influenza A H1N1 2009 in the emergency department were included. The test was requested according to the protocols established throughout the epidemic. Epidemiological, clinical, laboratory variables and outcomes were evaluated. RESULTS: A total of 456 cases were included, with a median age of 6.5years (PC(25-75) 3-10.6). There were risk factors of complications In 266 patients (59.4%) due to the influenza, mainly: respiratory (47%), cardiovascular (17%), neurological (14%) and immunosuppression (11%). The most frequent symptoms were fever (96%), (88%) cough, (72%) rhinorrhoea, muscle aches or asthenia and breathing difficulties and, less common, gastrointestinal and neurological symptoms. Chest X-ray was performed on 224 cases (49%), with lobar (31%) and interstitial (15%) infiltrates. One hundred and forty patients (31%) were hospitalised and 3.2% required Intensive Care Unit (median stay 4 and 3.5days, respectively). The most frequent complications were pneumonias and bronchospasms. Three patients died (a previously healthy patient with myocarditis and 2 patients with encephalopathy due to respiratory failure). Another case of myocarditis recovered with sequelae. CONCLUSIONS: The profile of patient with influenza A 2009 diagnosed in the emergency department was a school child, with risk factors of complications, presenting with respiratory symptoms and fever over a short time, and who can be discharged. It is important to emphasise myocarditis, as well as the usual respiratory complications of influenza virus.