Ingesta de psicofármacos: causa más frecuente de intoxicaciones pediátricas no intencionadas en España / Therapeutic psychotropic drugs: Most common cause of unintentional poisoning in children

INTRODUCCIÓN: El objetivo es conocer cuáles son los agentes más habitualmente implicados en las intoxicaciones medicamentosas no intencionadas que consultan en los Servicios de Urgencias Pediátricos (SUP) en España. MATERIAL Y MÉTODOS: Estudio descriptivo basado en un registro prospectivo de las intoxicaciones registradas en los 57 SUP participantes del Observatorio Toxicológico de la Sociedad Española de Urgencias de Pediatría entre octubre de 2008 y septiembre de 2013. RESULTADOS: En el periodo estudiado se registraron 639 intoxicaciones, de ellas 459 (71.8%) ingestas no intencionadas. Los agentes principales implicados fueron los fármacos (253, 55,1%), seguidos de los productos del hogar (137, 29,8%). Los grupos de fármacos más involucrados fueron los psicofármacos (62, 24,5%); de estos, 54 benzodiacepinas, anticatarrales (41, 16,2%) y antitérmicos (39, 15,4%). CONCLUSIONES: La causa más importante de consulta por una intoxicación no intencionada en la infancia en los SUP españoles es la ingesta de psicofármacos, sobre todo benzodiacepinas

INTRODUCTION: The aim of this article is to determine the most common substances involved in unintentional poisoning in children attending Pediatric Emergency Departments (PED) in Spain. METHODS: A descriptive study was conducted based on a prospective registry of the poisonings registered in the 57 PED participating in the Toxicology Surveillance System of the Spanish Society of Pediatric Emergencies between October 2008 and September 2013. RESULTS: A total of 639 poisoning were registered during the study period, 459 of them (71.8%) were unintentional. The most commonly involved substances were drugs (253, 55.1%) followed by household products (137, 29.8%). The drug groups most involved were psychotropic drugs (62, 24.5%), which included benzodiazepines (54), anti-catarrhal (41, 16.2%), and antipyretics (39, 15.4%). CONCLUSIONS: The most common reason for consulting Spanish PEDs is the unintentional ingestion of psychotropic drugs, mainly benzodiazepines

[Therapeutic psychotropic drugs: Most common cause of unintentional poisoning in children]. / Ingesta de psicofármacos: causa más frecuente de intoxicaciones pediátricas no intencionadas en España.

INTRODUCTION: The aim of this article is to determine the most common substances involved in unintentional poisoning in children attending Pediatric Emergency Departments (PED) in Spain. METHODS: A descriptive study was conducted based on a prospective registry of the poisonings registered in the 57 PED participating in the Toxicology Surveillance System of the Spanish Society of Pediatric Emergencies between October 2008 and September 2013. RESULTS: A total of 639 poisoning were registered during the study period, 459 of them (71.8%) were unintentional. The most commonly involved substances were drugs (253, 55.1%) followed by household products (137, 29.8%). The drug groups most involved were psychotropic drugs (62, 24.5%), which included benzodiazepines (54), anti-catarrhal (41, 16.2%), and antipyretics (39, 15.4%). CONCLUSIONS: The most common reason for consulting Spanish PEDs is the unintentional ingestion of psychotropic drugs, mainly benzodiazepines.

Diferencias territoriales en las intoxicaciones agudas en menores de 14 años en España / Regional differences in acute poisoning in under 14 year-old children in Spain

INTRODUCCIÓN: La identificación de variaciones en las intoxicaciones en diferentes regiones puede facilitar una prevención más eficaz. OBJETIVOS: Analizar el perfil de las intoxicaciones agudas pediátricas en diferentes regiones españolas. MATERIAL Y MÉTODOS: Registro prospectivo de las intoxicaciones registradas en 53 servicios de urgencias pediátricos incluidos en el Observatorio Toxicológico de la Sociedad Española deUrgencias de Pediatría entre 2008 y 2013. RESULTADOS: Se registraron 566 intoxicaciones en menores de 14 años, 458 (81,1%) por ingestas no voluntarias (mecanismo principal en todas las regiones). Las intoxicaciones por errores de dosificación fueron más habituales en Madrid (12,4% del total vs. 5% en el resto; p = 0,009); confin recreacional en la región Vasconavarra y Zaragoza (14,4 vs. 3,4% en el resto; p = 0,0008); porCO en Cataluña, Madrid y Otros (7,1 vs. 0,3%; p < 0,0001). CONCLUSIONES: Los perfiles de intoxicaciones agudas en menores de 14 años varían significativamente entre las diferentes regiones españolas

INTRODUCTION: The identification of variations in different profiles of pediatric poisonings may improve the prevention of these episodes. OBJECTIVES: To analyze the profile of pediatric acute poisonings in different regions of Spain. MATERIAL AND METHODS: A study was conducted, based on a prospective registry of the acute pediatric poisonings registered in 53 Spanish pediatric emergency departments included in the Toxicology Surveillance System of the Spanish Society of Pediatric Emergencies between 2008 and 2013. The regions were defined taking into account geographic factors, and the structuring of regional pediatric societies. RESULTS: A total of 566 poisoning were recorded in children less than 14 years. Poisonings due to dosage errors were more common in Madrid (12.4% of the whole group of poisonings vs 5.0% in the other regions, P = .009); recreational poisonings were more common in the Basque-Navarre region and Zaragoza (14.4% vs 3.4% in the others, P = .0008); and CO poisoning in Catalonia, Madrid and others (7.1% vs 0.3%, P < .0001). CONCLUSIONS: The profiles of acute poisonings in children less than 14 years vary significantly between the different Spanish regions. An epidemiological Surveillance System is a good tool to collect information in order to design preventive actions

[Regional differences in acute poisoning in under 14 year-old children in Spain]. / Diferencias territoriales en las intoxicaciones agudas en menores de 14 años en España.

INTRODUCTION: The identification of variations in different profiles of pediatric poisonings may improve the prevention of these episodes. OBJECTIVES: To analyze the profile of pediatric acute poisonings in different regions of Spain. MATERIAL AND METHODS: A study was conducted, based on a prospective registry of the acute pediatric poisonings registered in 53 Spanish pediatric emergency departments included in the Toxicology Surveillance System of the Spanish Society of Pediatric Emergencies between 2008 and 2013. The regions were defined taking into account geographic factors, and the structuring of regional pediatric societies. RESULTS: A total of 566 poisoning were recorded in children less than 14 years. Poisonings due to dosage errors were more common in Madrid (12.4% of the whole group of poisonings vs 5.0% in the other regions, P=.009); recreational poisonings were more common in the Basque-Navarre region and Zaragoza (14.4% vs 3.4% in the others, P=.0008); and CO poisoning in Catalonia, Madrid and others (7.1% vs 0.3%, P<.0001). CONCLUSIONS: The profiles of acute poisonings in children less than 14 years vary significantly between the different Spanish regions. An epidemiological Surveillance System is a good tool to collect information in order to design preventive actions.

Intoxicaciones en menores de 7 años en España. Aspectos de mejora en la prevención y tratamiento / Poisoning in children under age 7 in Spain. Areas of improvement in the prevention and treatment

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)

[Poisoning in children under age 7 in Spain. Areas of improvement in the prevention and treatment]. / Intoxicaciones en menores de 7 años en España. Aspectos de mejora en la prevención y tratamiento.

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.

Estudio descriptivo de los hemocultivos positivos en un servicio de urgencias pediátrico / Positive blood cultures in a pediatric emergency department: a descriptive analysis

Se describe las patologías y los microorganismos que causan bacteriemia y la influencia del hemocultivo (HC) positivo en urgencias en el manejo posterior. Se trata de un estudio retrospectivo de los HC positivos realizados en urgencias durante 2008 y 2009. Se consideró el cambio de la actitud terapéutica, el inicio o modificación del antibiótico y/o el ingreso hospitalario. Se realizaron 7.582 HC. En 382 (5,0%) hubo crecimiento bacteriano, 88 (23,0%) fueron verdaderos positivos. La neumonía y la infección urinaria fueron las principales patologías asociadas a bacteriemia y S. pneumoniae y E. coli los microorganismos más frecuentes. El HC positivo condicionó cambio de actitud terapéutica en un tercio de los episodios, principalmente en pacientes con fiebre sin foco. Se concluye que la positividad del HC condicionó un cambio de actitud terapéutica en un número significativo de pacientes, aunque dada la baja prevalencia de bacteriemia el impacto global fue bajo (AU)

We describe the infections and microorganisms causing bacteremia in an emergency department and to analyze the influence of a positive blood culture on subsequent management. It is a retrospective study of positive blood cultures ordered in the emergency department in 2008 and 2009. A change in therapeutic approach was defined as the initiation or modification of antibiotic therapy and/or hospital admission. A total of 7582 blood cultures were ordered. Bacteria grew in 382 (5.0%); 88 (23.0%) were true positives. Pneumonia and urinary tract infection were the main diagnoses associated with bacteremia. The pathogens implicated most often were Streptococcus pneumoniae and Escherichia coli. A positive blood culture led to a change in therapeutic approach in a third of the cases, mainly in patients with fever of unknown origin. We conclude that the management changed on the basis of blood culture findings in a significant number of cases although given the low prevalence of bacteremia, the overall impact was low (AU)

[Hospital admissions for varicella complications in children aged less than 15 years old]. / Hospitalizaciones por complicaciones de la varicela en niños menores de 15 años.

BACKGROUND: The complications of varicella are one of the arguments in favor of universal vaccination programs in children. OBJECTIVE: To describe the complications of varicella requiring hospital admission in a well-defined population (Gipuzkoa, Spain) and to compare the incidence of hospitalization with that reported in other series. MATERIAL AND METHODS: Observational, retrospective, multicenter study of admissions for varicella. The medical histories codified as varicella (minimum data set, CIE-0, codes 952.0-052.9) from 1 January 1993 to 31 December 2002 were reviewed. Calculation of hospitalization rates was based on emergency department visits and population data. The pediatric population of Gipuzkoa seeking medical attention at one of the four Basque Country Health Service hospitals in the area: Hondarribia, Mendaro, San Sebastian and Zumarraga. The mean coverage in Gipuzkoa is 54,999 children aged less than 15 years/year. All the children aged 0-15 years old admitted for more than 24 h with a discharge diagnosis of varicella complications. The variables studied are: age, gender, personal history, varicella immunization, immune status, fever, chest X-ray, complementary investigations, length of hospital stay, treatment, discharge diagnosis, clinical course, complications and sequelae at discharge. RESULTS: Seventy-one children were hospitalized. None had been vaccinated against the varicella-zoster virus. Eighty percent were aged less than 5 years and three were immunocompromised. Fifty-six percent had bacterial superinfection and invasive forms were found in seven patients. The mean length of admission was 6.5 days +/- 5.1. No deaths or sequelae were reported. CONCLUSIONS: The annual incidence rate of admissions longer than 24 hours due to varicella complications was 12.9 cases per 100,000 children aged less than 15 years, representing 0.31% of all annual admissions in this age group.

Hospitalizaciones por complicaciones de la varicela en niños menores de 15 años / Hospital admissions for varicella complications in children aged less than 15 years old

Antecedentes Las complicaciones por varicela se consideran una de las indicaciones que apoyan la cobertura vacunal universal. Objetivo Describir las complicaciones por varicela que han precisado hospitalización en una población definida (Guipuzkoa, España) y comparar la incidencia de hospitalizaciones con otras series. Material y métodos Estudio multicéntrico, retrospectivo, observacional, por revisión de historias clínicas, codificadas como varicela (CMBD, CIE-9, códigos 052.0-052.9) desde 1 de enero de 1993 a 31 de diciembre de 2002, y cálculo de las tasas de hospitalización en base a las urgencias asistidas y a los datos poblacionales. Población infantil de Guipuzkoa (España) asistida en el ámbito geográfico de los servicios de pediatría de los hospitales de agudos de Osakidetza-Servicio Vasco de Salud de Hondarribia, Mendaro, San Sebastián y Zumárraga, con una cobertura poblacional media de 54.999 niños menores de 15 años por año. Todos los niños y niñas de 0 a 15 años de edad, hospitalizados más de 24 h con el diagnóstico de varicela complicada. Se estudiaron las siguientes variables: edad, sexo, antecedentes personales, vacuna antivaricela, estado inmunológico, fiebre, radiografía de tórax, exámenes complementarios, duración del ingreso, tratamiento, diagnósticos de alta, evolución, complicaciones y secuelas al alta. Resultados Ingresaron 71 niños no vacunados frente al virus varicela-zoster, 80 por ciento menores de 5 años de edad, 68 inmunocompetentes y 3 no inmunocompetentes. Han predominado las sobreinfecciones bacterianas (56 por ciento) y destacan 7 casos con enfermedad invasiva. La estancia media ha sido de 6,50 5,15 día, sin mortalidad y sin secuelas. Conclusiones La incidencia anual de ingresos hospitalarios por varicela complicada superiores a 24 h ha sido 12,90 casos por cada 100.000 menores de 15 años, lo cual representa el 0,31 por ciento de los ingresos anuales hospitalarios en ese grupo (AU)