Retinal hemorrhages due to intracranial hypertension, is it possible to differentiate them from those associated with abuse?

BACKGROUND: Retinal hemorrhages (RHs) are suggestive of abusive head trauma (AHT). Even so, controversy persists about other possible causes, a fact that hinders the diagnosis of abuse. OBJECTIVE: To determine the prevalence and patterns of RHs associated with increased intracranial pressure (ICP) in young children. PARTICIPANTS AND METHODS: Prospective, single center study of children aged 29 days-3 years undergoing a lumbar puncture with opening pressure (OP) measured during routine clinical care in the emergency department, over a 4-year period. Children with known causes of RHs were excluded. All the children underwent a detailed ophthalmological examination within 72 h of admission. For children with RHs, an in-depth investigation was carried out to rule out AHT. RESULTS: Thirty-four patients were included: 20(58.8 %) were boys, median age 11.7 months (range 1-33 months). Overall, 29(85.3 %) had clinical findings of increased ICP. The duration of symptoms was ≤4 days in all patients except one, in whom it was 1.5 months. The median OP was 27cmH2O (range 20-60cmH2O). One of the children was found to have RHs, with evaluation resulting in a diagnosis of AHT. No RHs were found in any of the others studied. Using the Wilson method, we can be confident to an upper limit of 95 % that the probability of RHs occurring secondary to increased ICP alone is at most 0.1. CONCLUSIONS: RHs were not detected in patients with isolated nontraumatic increased ICP, measured via OP and diagnosed in the ED. Therefore, if RHs are detected, investigation into the possibility of AHT is warranted.

Cribado de maltrato en urgencias, una asignatura pendiente / Screening for abuse in Emergency Departments: A pending issue

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Implicación de las sustancias psicoactivas en las consultas de adolescentes en urgencias / Psychoactive drugs use and - related visits of adolescents to the emergency department

Fundamento y objetivos: Describir la consultas relacionadas con el consumo de sustancias psicoactivas (SP) generadas por adolescentes en un servicio de urgencias (SU) y valorar posibles características diferenciales en el perfil de los pacientes en función de la SP consumida. Pacientes y método: Estudio analítico y observacional. Se incluyeron durante 30 meses las consultas de adolescentes a un SU relacionadas con consumo de SP; se compararon las intoxicaciones etílicas aisladas (grupo 1) con las de otras SP (grupo 2). Resultados: Se incluyeron 333 consultas de 321 pacientes. Su edad media fue 16,1 años (DE: 1,1). Doscientos sesenta y dos pacientes (78,7%) habían consumido alcohol y 110 (33%) habían consumido otras SP. En total, en el grupo 1 se incluyeron 223 consultas y en el grupo 2 se incluyeron 110 consultas. En el grupo 2 se detectó mayor proporción de varones, más residentes en centros de menores y más adolescentes con antecedentes psiquiátricos que en el grupo 1. Asimismo, la distribución de las consultas del grupo 2 fue menos previsible que la del grupo 1. Conclusiones: Las SP generan frecuentemente consultas en el SU. Parece que los adolescentes con problemas psicosociales consumen más SP diferentes del alcohol y sus consultas son menos predecibles en el tiempo (AU)

Background and objectives: To describe psychoactive substances (PS)-related visits of adolescents to the emergency department and to explore possible differential features in patients according to the kind of PS consumed. Patients and methods: Observational and analytic study. PS-related visits of adolescents to the emergency department during 30 months were studied. Patients were divided in two groups: those with alcohol intoxication only (Group_1) and those with other PS (Group_2) and they were compared. Results: 333consults were included, corresponding to 321 patients. Their mean age was 16,1years (SD:1,1years). Two hundred sixty-two(78,7%) were alcohol-related visits, and 110(33%) were related with another PS consumption. Of the 262 alcohol-related visits, 223 were only related with alcohol(Group_1), while the other 110visits made up Group_2. Group_2 was composed of more males, more adolescents placed in Institutional Care and more adolescents with psychiatric records than Group_1. Likewise, distribution of Group_2 visits was less predictable than distribution of Group_1. Conclusions: PS consumption is a frequent major complaint in an Emergency Department. There are more poly-intoxications in males with psycho-social problems. In those cases, consumption seems to happen regardless of the time in the day or the day of the week (AU)

Minor head trauma and linear skull fracture in infants: cranial ultrasound or computed tomography?

OBJECTIVE: To determine the clinical evolution of children with skull fractures as a result of a minor head trauma from a witnessed accidental fall that have been studied by transfontanellar ultrasound (TFUS). METHODS: Observational study for 2 years (2004-2006) of children up to 1 year of age who suffered a skull fracture after minor head trauma and for whom a TFUS was carried out as the first neuroimaging test to rule out intracranial injuries. RESULTS: One hundred and twenty-three children were evaluated. The mean age was 5.7 months (SD 2.9) and the most common mechanism of injury was rolling off the bed. In seven (5.7%) patients, a computed tomography (CT) was eventually performed after TFUS; in two of these patients, this was because of the detection of possible intracranial alterations and in the others, it was because of a small fontanelle. Both patients with abnormal TFUS had a small epidural haematoma on the CT scan that did not need surgery. The clinical course for all patients was uneventful. CONCLUSION: TFUS is a valid and reliable alternative to CT for minor head trauma in infants with skull fractures. Its innocuousness and cost-effectiveness in comparison with CT makes it a good choice in this situation.