Estudio retrospectivo de los pacientes con diagnóstico confirmado de tosferina que son atendidos en urgencias de un hospital de tercer nivel / Retrospective study of patients with a confirmed diagnosis of whooping cough treated in the emergency room of a tertiary hospital

INTRODUCCIÓN: se analizan las características clínicas, pruebas complementarias y tratamientos recibidos por los pacientes con diagnóstico de tosferina que son valorados en Urgencias de Pediatría. MATERIAL Y MÉTODOS: estudio descriptivo retrospectivo de los casos de tosferina que consultaron en Urgencias de Pediatría de un hospital de tercer nivel entre marzo de 2014 y octubre de 2017. RESULTADOS: se analizaron 89 casos (55% mujeres) con edad media de 1,67 ± 2,9 años. El 98,9% presentó tos, el 33% gallo inspiratorio y el 34,8% apneas. En el 64% de los casos había entorno epidémico de tos o tosferina. La media de visitas en urgencias durante el mismo proceso fue 1,4. Diagnósticos más frecuentes en la primera visita a urgencias: tos (36%), sospecha de tosferina (22,5%), infección respiratoria de vías altas (19,1%) y bronquiolitis (9%). Ingresaron 56 pacientes (62,9%), con una edad media de 0,38 ± 1,2 años. Se realizó cultivo para Bordetella en 88 casos (positivo para B. pertussis en 38 y B. parapertussis en tres) y reacción en cadena de la polimerasa en 73 (positivo para B. pertussis en 70 y B. parapertussis en tres). CONCLUSIONES: el diagnóstico de tosferina habitualmente es difícil, ya que la sintomatología inicialmente es inespecífica. El diagnóstico precoz es fundamental para iniciar un tratamiento inmediato y realizar una adecuada profilaxis de contactos

INTRODUCTION: the aim of the study was to analyse the clinical characteristics, diagnostic tests performed and treatment used in patients with pertussis evaluated in the paediatric emergency setting. MATERIAL AND METHODS: we conducted a retrospective descriptive study of patients with pertussis that sought care in the paediatric emergency department of a tertiary care hospital between March 2014 and October 2017. RESULTS: the sample included 89 patients with a mean age of 1.67 ± 2.9 years. Of the total, 98.9% presented with cough, 33% with inspiratory whoop and 34.8% with apnoea. Sixty-four percent of cases occurred in the context of an epidemic of cough or pertussis. The mean number of emergency visits made during a single episode of disease was 1.4. The most frequent diagnoses in the initial emergency visit were cough (36%), suspected pertussis (22.5%), upper respiratory tract infection (19.1%) and bronchiolitis (9%). Fifty-six patients were admitted to hospital (62.9%) with a mean age of 0.38 ± 1.2 years. Cultures for detection of Bordetella were performed in 88 cases (positive for B. pertussis in 38 and B. parapertussis in 3), and PCR tests in 73 (positive for B. pertussis in 70 and B. parapertussis in 3). CONCLUSIONS: the diagnosis of pertussis is usually challenging, as its initial symptoms are nonspecific. Early diagnosis is essential for early initiation of treatment and adequate contact prophylaxis

Escabiosis: lesiones pruriginosas altamente contagiosas / Scabies: highly contagious pruritic lesions

La escabiosis es una infestación producida por Sarcoptes scabiei, caracterizada por lesiones generalizadas pruriginosas. El diagnóstico es eminentemente clínico. Síntomas compatibles en varios miembros de la misma familia se consideran diagnósticos. El tratamiento consiste en la aplicación de Permetrina al 5% en la superficie cutánea.

Scabies is an infestation produced by Sarcoptes scabiei. Itchy generalized lesions characterized this pathology. The diagnosis is clinical. Compatible symptons presented in some members of the same family are considered diagnostic. The treatment is based in the application of Permetrine 5% in all the cutaneous area.

Evaluation and Impact of the "Advanced Pediatric Life Support" Course in the Care of Pediatric Emergencies in Spain.

INTRODUCTION: The Advanced Pediatric Life Support (APLS) course was introduced in the training of professionals who care for pediatric emergencies in Spain in 2005. OBJECTIVE: To analyze the impact of the APLS course in the current clinical practice in Spanish PEDs. METHODS: The directors of APLS courses were asked about information regarding the courses given to date, especially on the results of the satisfaction survey completed by students at the end of the course. Furthermore, in December 2014, a survey was conducted through Google Drive, specifically asking APLS students about the usefulness of the APLS course in their current clinical practice. RESULTS: In the last 10 years since the APLS course was introduced in Spain, there have been 40 courses in 6 different venues. They involved a total of 1520 students, of whom 958 (63.0%) felt that the course was very useful for daily clinical practice. The survey was sent to 1,200 students and answered by 402 (33.5%). The respondent group most represented was pediatricians, 223 (55.5%), of whom 61 (27.3%) were pediatric emergency physicians, followed by pediatric residents, 122 (30.3%). One hundred three (25.6%) respondents had more than 10 years of professional practice and 291 (72.4%) had completed the course in the preceding four years. Three hundred forty-one of the respondents (84.9%: 95% confidence interval [CI], 81.9-87.9) said that they always use the pediatric assessment triangle (PAT) and 131 (32.6%: 95% CI, 28-37.1) reported that their organization has introduced this tool into their protocols. Two hundred twenty-three (55.5%: 95% CI, 50.6-60.3) believed that management of critically ill patients has improved, 328 (81.6%: 95% CI, 77.8-85.3) said that the PAT and the systematic approach, ABCDE, help to establish a diagnosis, and 315 (78.4%: 95% CI, 74.3-82.4) reported that the overall number of treatments has increased but that these treatments are beneficial for patients. Hospital professionals (191; 47.5%) include the PAT in their protocols more frequently than pre-hospital professionals (68.5% vs 55.4%; p <0.01) and consider PAT useful in the management of patients (60.2% vs 51.1%; p <0.05). Neither the time elapsed since the completion of the course, nor category and years of professional experience had any influence on the views expressed about the impact of the APLS course in clinical practice. CONCLUSIONS: Most health professionals who have received the APLS course, especially those working in the hospital setting, think that the application of the systematic methods learned, the PAT and ABCDE, has a major impact on clinical practice.

Impacto de la instauración de un protocolo de actuación clínica ante el dolor abdominal en urgencias pediátricas / Impact of establishment of a clinical protocol for abdominal pain in pediatric emergencies

Objetivos: En enero de 2013 se implantó un protocolo de actuación para el manejo del dolor abdominal en el servicio de urgencias de pediatría, que pretendía reducir la realización de radiografías de abdomen no indicadas, disminuir la administración de enemas no indicados y aplicar una pauta de analgesia mayor. Se ha revisado el impacto del protocolo sobre la modificación de la práctica clínica y si estas variaciones se mantienen. Material y métodos: Estudio observacional, descriptivo, analítico y retrospectivo, realizado en 684 pacientes que acudieron al servicio de urgencias por presentar dolor abdominal de causa aparentemente no orgánica, distribuidos en cuatro periodos: diciembre de 2012 (P1), febrero de 2013 (P2), noviembre de 2013 (P3) y mayo de 2015 (P4). Se han recogido los datos sobre las pruebas diagnósticas realizadas y los tratamientos empleados en estos pacientes. Resultados: Radiografía abdominal: P1= 14,7%, P2= 6,9%, P3= 1,8%, P4= 0% (p <0,01); pacientes con estreñimiento: P1= 23,4%, P2= 13,5%, P3= 0%, P4= 0% (p= 0,001). Ecografía abdominal: P1= 11%, P2= 12,5%, P3= 9,4%, P4= 10,1% (p >0,05). Administración de enema en el servicio de urgencias: P1= 21,5%, P2= 8,3%, P3= 17,1%, P4= 11,7% (p= 0,005); pacientes con estreñimiento: P1= 51,1%, P2= 21,6%, P3= 31,3%, P4= 32,5% (p= 0,036). Tratamiento con polietilenglicol: P1= 4,3%, P2= 6,3%, P3= 9,8%, P4= 4,7% (p >0,05); pacientes con estreñimiento: P1= 12,8%, P2= 21,6%, P3= 40,6%, P4= 20,5% (p= 0,034). Pauta de analgesia: P1= 42,9%, P2= 53,5%, P3= 53,7%, P4= 62,7% (p= 0,02). Reconsultas al servicio de urgencias: P1= 10,4%, P2= 2,1%, P3= 1,8%, P4= 13% (p <0,01). Conclusiones: El protocolo ha logrado reducir de forma significativa la realización de radiografías abdominales y el empleo de enemas rectales. Ha aumentado la prescripción de analgesia en pacientes con dolor abdominal. El protocolo ha logrado homogeneizar la actuación de los profesionales, disminuyendo el riesgo de yatrogenia y aumentando el confort de los pacientes y sus familias (AU)

Objectives: In January 2013 a protocol for the management of abdominal pain at pediatric emergency was implanted, with the following objectives: reducing abdominal radiographs not indicated, reduce treatment with enemas not indicated and more prescription of analgesia. It has been reviewed the impact of the protocol on changing clinical practice and whether these variations are maintained. Material and methods: Retrospective, descriptive and analytical observational study with 684 patients attending emergency department for abdominal pain apparently no organic cause, divided into four periods: December 2012 (P1), February 2013 (P2), November 2013 (P3) and May 2015 (P4). We collected data about diagnostic tests performed and treatments used in these patients. Results: Abdominal radiography: P1= 14.7%, P2= 6.9%, P3= 1.8%, P4= 0% (p <0.01); constipated patients: P1= 23.4%, P2= 13.5%, P3= 0%, P4= 0% (p= 0.001). Abdominal ultrasound: P1= 11%, P2= 12.5%, P3= 9.4%, P4= 10.1% (p >0.05). Patients treated with rectal enema: P1= 21.5%, P2= 8.3%, P3= 17.1%, P4= 11.7% (p= 0.005); constipated patients: P1= 51.1%, P2= 21.6%, P3= 31.3%, P4= 32.5% (p= 0.036). Patients treated with polyethylenglycol: P1= 4.3%, P2= 6.3%, P3= 9.8%, P4= 4.7% (p >0.05); constipated patients: P1= 12.8%, P2= 21.6%, P3= 40.6%, P4= 20.5% (p= 0.034). Patients treated with analgesia: P1= 42.9%, P2= 53.5%, P3= 53.7%, P4= 62.7% (p= 0.02). Reconsultations the emergency department: P1= 10.4%, P2= 2.1%, P3= 1.8%, P4= 13% (p <0.01). Conclusions: The protocol has reduced significantly the performance of abdominal radiographs and use of rectal enemas. It has increased the prescription of analgesia in patients with abdominal pain. Protocol has managed to standardize the medical intervention, reducing the risk of iatrogenic and increasing comfort for patients and their families (AU)

Perfil epidemiológico del paciente pediátrico intoxicado atendido en urgencias / Epidemiological profile of the paediatric patient managed at the emergency unit due to intoxication

Objetivo: describir el perfil epidemiológico del paciente pediátrico intoxicado, atendido en el servicio de urgencias del Hospital Infantil Universitario Miguel Servet de Zaragoza durante los años 2012-2014, analizando los factores asociados. Método: estudio descriptivo transversal. Se seleccionó la población que cumplía criterios CIE-9 E850-E858, E860-E869 y E905. Variables: edad, sexo, utilización de recursos sanitarios, contacto con el servicio de información toxicológica (SIT), tóxico involucrado, tipo de fármaco, voluntariedad en la exposición, procedencia del paciente, lugar de exposición, pruebas complementarias, hora y día de atención. Para el análisis estadístico se utilizó la prueba de H de Kruskal Wallis y el test de Chi cuadrado con un p valor < 0,001. Resultados: se detectaron 482 episodios de intoxicaciones. El 67,7% era menor de 5 años y el 48,5% acudió por intoxicaciones farmacológicas, principalmente psicofármacos. La razón de masculinidad fue 0,508. El 72% de los pacientes no había hecho uso de otros recursos sanitarios previamente. La voluntariedad en la exposición a tóxicos supuso el 17% y el principal tóxico implicado fueron los fármacos (48,5%), especialmente los psicofármacos (27,2%). Un 97,3% no entró en contacto con el SIT. El 62% de los mayores de 12 años llegó en ambulancia, con una asociación estadísticamente significativa con el alcohol. Conclusiones: el perfil epidemiológico de las intoxicaciones agudas fue de niño menor de 5 años, atendido en fin de semana, a causa de la ingesta de psicofármacos y con apenas actuación de primeros intervinientes. La prevención primaria en centros de salud debería ser una actuación clave para la disminución de las intoxicaciones pediátricas (AU)

Objective: to describe the epidemiological profile of the paediatric patient managed due to intoxication at the Emergency Unit of the Hospital Infantil Universitario Miguel Servet in Zaragoza during the years 2012 to 2014, analyzing all associated factors. Method: a descriptive transversal study. The population selected met the CIE-9 E850-E858, E860-E869 and E905 criteria. Variables: age, gender, use of healthcare resources, contact with the Toxicological Information Services (TIS), toxic substance involved, type of drug, voluntary exposure, origin of the patient, place of exposure, complementary tests, hour and day of medical care. Kruskal-Wallis H Test and Chi Square test were used for statistical analysis, with p value < 0.001. Results: in total, 482 intoxication episodes were detected; 67.7% were <5-year old, and 48.5% consulted due to pharmacological intoxications, mainly by psychotropic drugs. There was a 0.508 rate of male patients. Overall, 72% of patients had not used any healthcare resources previously. There was a 17% voluntary exposure to toxic substances, and medical drugs were the main substance involved (48.5%), particularly psychotropic agents (27.2%). In 97.3% of cases there was no contact with the TIS; 62% of > 12-year-old patients arrived by ambulance, with a statistically significant association with alcohol. Conclusions: the epidemiological profile of acute intoxications consisted in a < 5-year-old boy, seen during the weekend, due to the intake of psycotropic drugs, and with little action by the first responders. Primary prevention in health centres should be a key action for the reduction in paediatric intoxications (AU)

Reconsultas en una unidad de urgencias pediátricas / Return visits to a paediatric emergency department

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Unidad de Urgencias de Pediatría del Hospital Infantil Universitario Miguel Servet / Emergency unit of pediatrics of the Hospital Infantil Universitario Miguel Servet

La Unidad de Urgencias de Pediatría del Hospital Universitario Miguel Servet de Zaragoza, centro de referencia de la Comunidad Autónoma de Aragón, tiene un compromiso con las líneas estratégicas del centro, destacando la actividad asistencial, docencia e investigacion clínica en las que están involucrados todos los profesionales de la Unidad. Su finalidad está centrada en el paciente y sus familias, en la resolución urgente de todas las situaciones clínicas que requieran atención inmediata por problemas médicos, quirúrgicos o traumatológicos, en el menor tiempo posible, con la mayor efectividad y con una óptima calidad científico- técnica, durante las 24 horas del día, todos los días del año. Exponemos los principales datos asistenciales, docentes y de investigación (AU)

The Children’s Emergency Department at the Miguel Servet University Hospital in Zaragoza, as a reference centre in Aragon, has a commitment to the hospital strategies emphasising health care, teaching and research activities, in which all professionals Working in the department are involved. Its purpose is, focused on the patient and their family, the urgent solution to all clinical situations requiring immediate attention due to medical, surgical or trauma problems with the greatest effectiveness and optimum scientific and technical quality 24 hours a day, every day of the year (AU)

Recogida de orina en el lactante febril para el diagnóstico de la infección urinaria en Urgencias / Collection of urine in febrile infants for diagnosis of urinary tract infection in the Emergencies’ room

Introducción: la infección del tracto urinario (ITU) es una enfermedad frecuente en niños. Resulta fundamental una adecuada recogida de orina para evitar falsos positivos, minimizando procedimientos invasivos. La recogida de orina al acecho es una técnica incruenta, con baja tasa de contaminación, por lo que se estableció como método de elección al actualizar nuestro protocolo clínico. Material y métodos: estudio prospectivo longitudinal descriptivo y analítico, realizado en el Servicio de Urgencias de un hospital terciario, en dos periodos, antes y después de la actualización del protocolo. Se analizaron: edad, sexo, tiempo en Urgencias, método de recogida, sedimento y cultivo de orina y diagnóstico, en pacientes febriles menores de tres años. Resultados: hubo 140 pacientes en 2012 y 180 en 2011, sin diferencias en distribución por sexo y edad. Las medias etarias fueron 12 y 14 meses respectivamente. El 35,7% se recogieron por acecho en 2012, frente al 7,8% de 2011 (p<0,001). En 2011 fueron necesarias más confirmaciones: 20,5% frente a 10,7% en 2012. No hubo diferencias significativas en el número de sospechas de ITU ni en el de muestras contaminadas en ambos años. Tampoco entre las muestras recogidas por acecho o sondaje en 2012. El tiempo medio de estancia en Urgencias en 2011 fue 221 minutos, siendo 190 en 2012 (p<0,05). Conclusiones: la recogida de orina mediante el acecho constituye un método sencillo y no invasivo, que generalmente no precisa confirmación, por lo que reduce el tiempo de espera en el Servicio de Urgencias. No se ha objetivado un aumento de falsos diagnósticos de ITU en pacientes con muestra recogida por acecho (AU)

Introduction: urinary tract infection (UTI) in children is a common process. It is essential to find an adequate method to collect urine, to avoid false positives, minimizing invasive procedures. Clean catch urine (CCU) is a noninvasive technique, with low contamination rate, so it has been established as the recommended method for urine collection to update our clinical protocol. Material and methods: a prospective longitudinal descriptive and analytical study was conducted in a tertiary hospital in the Emergencies’ room (ER) in two periods, before and after the update protocol. Age, sex, time in the ER, collection method, sediment and urine culture and diagnosis in febrile patients <3 years were analyzed. Results: there were 140 patients in 2012 and 180 in 2011, with no differences in age and sex distribution. The mean ages were 12 and 14 months respectively. 35.7% of the samples were collected by CCU in 2012, compared to 7.8% in 2011 (p<0.001). In 2011 more confirmations of urine analysis were necessary: 20.5% vs. 10.7% in 2012. There were no significant differences between the number of suspected UTI or the contaminated samples in both years. Neither did between samples collected by catheterization or CCU in 2012. The average length of stay in the ER in 2011 was 221 minutes, while 190 in 2012 (p<0.05). Conclusions: urine collection by CCU is a simple and noninvasive method, which usually does not require confirmation, thereby reducing the wait time in the ER. There has not been an objectified increased of false diagnosis of UTI in patients with sample collected by CCU (AU)

Pediatricians' attitudes and costs of bronchiolitis in the emergency department: a prospective multicentre study.

BACKGROUND: How pediatricians manage bronchiolitis and the derived total costs (direct and indirect) in the emergency department (ED) have not been fully characterized. The aim of the present study is to calculate those costs in a European country. METHODS: A prospective and observational study, including 10 EDs of tertiary hospitals throughout Spain and during the bronchiolitis season 2010-2011, was performed. Every ED recruited children on random days of the week (3 days per week; always including one non-working day per every week). Recruitment aimed at a total sample size of 600 children. Direct (diagnostic procedures, time spent in the ED and medication) and indirect costs (work hours lost by parents, babysitting, travels, and meals) were collected. Comparisons between bronchiolitis caused by respiratory syncytial virus (RSV) and non-RSV bronchiolitis, as well as costs across severity categories were performed with the Kruskal-Wallis test. A multiple regression model was built to assess the influence of several of the studied factors on the total costs, including a RSV positive test and episode severity as independent variables; and gender, age, attending nursery school, preterm birth, low birth weight, smoker mother during pregnancy, and current smoker father as covariates. RESULTS: From the 664 recruited children, direct mean costs were €213.2 ± 91.8 and indirect ones were €35.9 ± 55.3; the total costs being €249.2 ± 122.9. Costs were significantly higher in children positive to RSV and rose with increased severity. Those associations were maintained in the multiple regression analysis. CONCLUSIONS: Although relatively low at the individual level (€249.2, mean total cost) the costs for just the ED expenses of bronchiolitis in Spain would add up to about €20 million per year.

[Bicycle accidents treated in emergency departments. A multicentre study]. / Accidentes de bicicleta atendidos en los Servicios de Urgencias. Estudio multicéntrico.

OBJECTIVES: To describe epidemiological characteristics, types of injury, prognosis and medical management of bicycle-related Paediatric Emergency Department (ED) visits and to identify potential preventive measures. PATIENTS AND METHODS: This multicentred, observational prospective study included all children between 3 and 16 years of age treated for bicycle-related injuries in the Emergency Departments of 15 Spanish Hospitals belonging to the «Unintentional Paediatric Injury Workshop¼ of the Spanish Paediatric Emergency Society between the 1(st) of June 2011 and the 31(st) of May 2012. Characteristics of all ED visits, as well as epidemiological data and accident-related information, were collected. RESULTS: A total of 846 patients were included in the study, with a male predominance (72.9%) and a median age of 9.6 ± 3.6 years. Head injury was the third most common injury (22.3%) and the main cause of admission to the Pediatric Intensive Care Unit (PICU) (68.4%). More than three-quarters (77.9%) of the patients did not wear a helmet, which was significantly associated to a higher incidence of head injury and admission to PICU. Older children (OR 1.063) and bicycle injuries involving motor vehicles (OR 2.431) were identified as independent risk factors for worse outcomes. CONCLUSIONS: Since helmet use reduces up to 88% of central nervous system lesions secondary to head injury, promotion of its use should be the main preventive measure, followed by restriction of bike-riding to cycling areas.

La reacción anafiláctica en Urgencias de Pediatría: Revisión y comentarios / Anaphylactic reaction in Pediatric Emergency Service: A review and comments

Introducción. La anafilaxia en un síndrome multisistémico potencialmente fatal que con frecuencia se presenta de forma inesperada. Precisa un reconocimiento y tratamiento precoces, siendo el fármaco de elección la adrenalina intramuscular. Es muy importante un periodo de observación debido a que hasta en el 20% de los casos puede aparecer una reacción bifásica de igual o mayor intensidad. Objetivos. Evaluación del cambio en el manejo de las reacciones anafilácticas de nuestro Servicio de Urgencias Pediátricas tras la modificación del protocolo introduciendo las últimas recomendaciones de la EAACI (Academia Europea de alergología e Inmunología Clínica) en el 2007. Métodos. Estudio descriptivo retrospectivo de dos cohortes históricas revisando los informes de atención de Urgencias. La primera cohorte, de junio de 2005 a octubre de 2007 y la segunda cohorte, de enero a diciembre de 2008, tras la actualización de nuestro protocolo. Resultados. En la primera cohorte se recogieron un total de 9 casos, con una edad media de 4,3 años. Todos ellos fueron de gravedad leve-moderada. Un alimento fue el causante en la mayoría de los casos. Sólo en 5 casos se administró adrenalina. 8 de los pacientes permanecieron en observación y 4 se derivaron a consultas de Alergología. En la segunda cohorte, se recogieron un total de 17 casos, con una edad media de 5,9 años. Todos los casos fueron leve-moderados. Sólo en 10 casos se relacionó su etiología, siendo un alimento lo más frecuente y utilizándose en 13 casos la adrelina vía intramuscular. Todos los pacientes permanecieron en observación y 16 de ellos se derivaron a consultas de Alergología. Conclusiones. Es importante la existencia y actualización de protocolos en las Urgencias de Pediatría. En nuestra Unidad hemos mejorado en el reconocimiento y manejo de las reacciones anafilácticas en urgencias tras la actualización de nuestro protocolo basada en las últimas recomendaciones dadas por la EAACI (AU)

Background. Anaphylaxis is a potentially fatal multisystem syndrome that often occurs unexpectedly. Accurate recognition and early treatment remain the drug of choice for intramuscular adrenaline. It is very important observation period because up to 20% of cases may appear biphasic reaction of equal or greater intensity. Objective. Evaluation of the change in the managing of the anaphylactic reactions of our service of pediatric emergency after the modification of the protocol introducing the last recommendations of the EAACI of the year 2007. Methods. Retrospective study of two cohorts historical We review the reports in emergency care. The first cohort, from June 2005 to October 2007 and the second cohort, form January to December 2008, after the upgrade of our protocol. Results. In the first cohort were collected a total of 9 cases, with an average age of 4.3 years. All were of mild to moderate severity. A food was the cause in most cases. Only in 5 cases was administered adrenaline. 8 patients remained under observation and 4 patients were derived to allergy clinics. In the second cohort were collected a total of 17 cases, with an average age of 5.9 years. All cases were mild to moderate. Only in 10 cases was related etiology, being a food more often and used in 13 cases intramuscular adrenaline. All patients remained under observation and 16 of them were derived to allergy clinics. Conclusions. It is important to the existence and maintenance of protocols in emergency pediatrics. In our unit we have improved the recognition and management of anaphylactic reactions in the emergency after the upgrade of our protocol based on the latest recommendations issued by the EAACI (AU)

Estrategias de mejora a partir de la evaluación continua de un protocolo: cefalea afebril en pediatría / No disponible

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Tomografía computarizada craneal en urgencias: revisión de 2 meses / Emergency cranial CAT scan: 2-month review

Introducción: Actualmente, la resonancia magnética cerebral ha sustituido en gran parte a la tomografía computarizada (TC) craneal, salvo en emergencias, donde la TC continúa siendo la técnica más utilizada, y de sus hallazgos pueden derivarse consecuencias diagnósticas y terapéuticas. Material y métodos: Se revisan las TC craneales realizadas en el Servicio de Urgencias de Pediatría del Hospital «Miguel Servet», de Zaragoza, durante un periodo de 2 meses, analizando las indicaciones y el ajuste a nuestros protocolos de actuación en urgencias. Resultados: En el periodo revisado se atendieron 9.769 pacientes en urgencias; de ellos, 413 presentaron patología susceptible de realizar TC craneal. Se realizaron 27 TC craneales urgentes: 6 traumatismos craneoencefálicos, 5 cefaleas, 5 episodios paroxísticos por sospecha de primer episodio convulsivo,3 primeras crisis no sintomáticas agudas, 2 estados convulsivos febriles, 2 encefalopatías agudas, 1 antes de punción lumbar, 1 por focalidad neurológica, 1 por hipertensión endocraneal y 1 por sospecha de disfunción valvular. Globalmente, se realizó una TC craneal al 3,4% de los pacientes con traumatismos craneoencefálicos, al 10,3% de los que presentaban cefaleas y al 100% de los que tenían primeros episodios convulsivos no sintomáticos agudos. Cinco (18,5%) de las TC realizadas mostraron una alteración intracraneal: 2 conocidas previamente y 3 de nuevo diagnóstico (11,1%). Todas las TC se ajustaron a nuestros protocolos. Discusión: Pese a los riesgos potenciales derivados de la radiación, defendemos la realización de TC craneal en los servicios de urgencias pediátricas, optimizando las indicaciones y aplicando las estrategias para reducir al mínimo la radiación. Es importante clarificar la relación real entre la radiación y el riesgo de cáncer, y potenciar nuevas tecnologías que minimicen los riesgos derivados de ésta (AU)

Introduction: At present, brain Magnetic Resonance Imaging (MRI) have primarily replaced cranial CAT scans, except in emergencies where CAT scans continue to be the most widely used techniques, which by means of their findings allow obtaining diagnostic and therapeutic consequences. Material and methods: We checked the cranial CAT scans, carried out in the pediatric Emergency Unit of Miguel Servet Hospital in Zaragoza in a period of 2 months, analyzing clinical indications and the adjustment to our performance protocols in the Emergency Department. Results: During the period reviewed, 9,769 patients wereseen in the Emergency Department: 413 of them showed pathology suitable for carrying out a cranial CAT scan. 27 emergency cranial CAT scans were carried out: 6 for traumatic brain injuries, 5 for cephaleas, 5 for paroxysmal episodes with a probable diagnosis of first seizure episode, 3 for acute asymptomatic first attacks, 2 for febrile convulsive status, 2 for acute encephalopathy’s, 1 CAT scan previous to a lumbar puncture, 1 for neurological focus, 1 for endocranial hypertension and 1 for asuspicion of valvular dysfunction. Cranial CAT scans were carried out as a whole in 3.4% of traumatic brain injuries, in 10.3%of cephaleas and in 100% of acute asymptomatic first seizure episodes. 5 (18.5%) of the CAT scans carried out showed an intracranial disorder: 2 which were previously known and 3with a new diagnosis (11.1%). All the CAT scans were adjusted to our protocols. Discussion: In spite of the potential risks produced by radiation, the performance of cranial CAT scans is supported in pediatric emergency services, while optimizing instructions and applying strategies for minimizing radiation. It is important to clarify the real ratio between radiation and cancer risk and to enhance new technologies capable of minimizing the risks produced by radiation (AU)

Evaluación del protocolo de punción lumbar diagnóstica en urgencias / Evaluation of the protocol for diagnostic lumbar puncture in the emergency department

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Autoevaluación del cumplimiento del protocolo de manejo del traumatismo craneoencefálico en niños menores de 1 año en urgencias / No disponible

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Autoevaluación del cumplimiento del protocolo del traumatismo craneoencefálico en urgencias en mayores de un año / No disponible

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