Evaluación de los indicadores de calidad en intoxicaciones pediátricas en un servicio de urgencias / Assessment of quality indicators in pediatric poisoning in an emergency service

INTRODUCCIÓN: La evaluación de indicadores de calidad permite comparar el proceso asistencial con un estándar, detectar deficiencias y aplicar acciones de mejora. MATERIAL Y MÉTODO: Se evaluaron los 20 indicadores de calidad en intoxicaciones pediátricas en todas las consultas por sospecha de intoxicación recibidas en el servicio de urgencias de un hospital de tercer nivel desde enero de 2011 a junio de 2012. La recogida de datos se realizó por revisión retrospectiva de las historias clínicas. RESULTADOS: Se alcanzó el estándar en 11 indicadores y no se alcanzó en 6: administración de carbón activado en las 2 primeras horas de la ingesta (estándar ≥ 90%, resultado = 83,5%); atención dentro de los 15 min desde la llegada a urgencias (estándar ≥ 90%, resultado = 60,4%); inicio de la descontaminación digestiva dentro de los 20 min desde la llegada a urgencias (estándar ≥ 90%, resultado = 29,7%); realización de electrocardiograma a los pacientes intoxicados con sustancias cardiotóxicas (estándar ≥ 95%, resultado = 87%); comunicación judicial de los casos de intoxicación que puede encubrir delito (estándar ≥ 95%, resultado = 31,3%) y registro del conjunto mínimo de datos del paciente intoxicado (estándar ≥ 90%, resultado = 1,9%). Tres indicadores no pudieron evaluarse debido al pequeño número de casos en el que eran aplicables (n < 5). CONCLUSIONES: Las principales deficiencias detectadas están en relación con el tiempo de asistencia, el registro de datos y la cumplimentación del parte judicial. La priorización de estos pacientes, el diseño de una lista de comprobación que recoja los aspectos más importantes de su manejo y la creación de campos de registro obligatorios en la historia clínica informatizada son acciones de mejora clave en este servicio de urgencias

INTRODUCTION: Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. MATERIAL AND METHOD: Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. RESULTS: A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2 hours of poison ingestion (standard = 90%, result = 83.5%); attention within the first 15 minutes of arriving in the emergency service (standard = 90%, result = 60.4%); start of gastrointestinal decontamination within 20 minutes of arrival in emergency services(standard = 90%, result = 29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard = 95%, result = 87%); judicial communication of cases of poisoning that could conceal a crime (standard = 95%, result = 31.3%), and collection of the minimal set of information of poisoned patients (standard = 90%, result = 1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (<5). CONCLUSIONS: The main deficiencies are related to delay in assistance, collection of information and completion of judicial reports. Giving these patients priority, designing a checklist to collect the main points of their management, and creating obligatory fields for data in computerized medical records, are the main actions available to achieve pediatric poisoning quality indicators in this emergency service

[Assessment of quality indicators in pediatric poisoning in an emergency service]. / Evaluación de los indicadores de calidad en intoxicaciones pediátricas en un servicio de urgencias.

INTRODUCTION: Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. MATERIAL AND METHOD: Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. RESULTS: A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2hours of poison ingestion (standard=90%, result=83.5%); attention within the first 15minutes of arriving in the emergency service (standard=90%, result=60.4%); start of gastrointestinal decontamination within 20minutes of arrival in emergency services (standard=90%, result=29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard=95%, result=87%); judicial communication of cases of poisoning that could conceal a crime (standard=95%, result=31.3%), and collection of the minimal set of information of poisoned patients (standard=90%, result=1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (<5). CONCLUSIONS: The main deficiencies are related to delay in assistance, collection of information and completion of judicial reports. Giving these patients priority, designing a checklist to collect the main points of their management, and creating obligatory fields for data in computerized medical records, are the main actions available to achieve pediatric poisoning quality indicators in this emergency service.

Fiebre, astenia, mialgia y soplo por mixoma cardíaco / Fever, asthenia, myalgia and murmur due to cardiac myxoma

Los tumores cardíacos son infrecuentes, sobre todo en la edad pediátrica, y en su mayoría son benignos. Los mixomas son excepcionales en pediatría, aunque son los más frecuentes en el adulto. La mayoría se encuentra en la aurícula izquierda, presentándose en un 25% en la derecha. Su cuadro clínico depende principalmente de la ubicación del tumor. Una característica de estos tumores es que se pueden acompañar de clínica sistémica y de alteraciones analíticas. La ecocardiografía es el estudio de elección y debe realizarse su resección temprana para evitar complicaciones graves. Se presenta el caso de una niña de 10 años diagnosticada de un mixoma auricular derecho a partir de una clínica de fiebre, mialgias, astenia y alteraciones analíticas. Se llega al diagnóstico mediante ecocardiografía; se realiza la exéresis de la tumoración sin incidencias y presenta buena evolución posquirúrgica (AU)

Cardiac tumours are rare, especially in children, and most of them are benign. Myxomas are unusual in children, being more common among adults. They are usually located in the left atrium, with 25% appearing in the right. The clinical signs and symptoms depend mainly on where the tumour is located. A feature of these tumours is that they can be accompanied by constitutional symptoms and laboratory abnormalities. Echocardiography is the study of choice, and a prompt resection is required to prevent serious complications. We present a case of a 10 year-old girl diagnosed with right atrial myxoma who presented with a fever, myalgia, asthenia and laboratory abnormalities. Diagnosis was made by echocardiography, and the early surgical resection of the tumour ran smoothly and showed a good postoperative recovery (AU)

[Fever, asthenia, myalgia and murmur due to cardiac myxoma]. / Fiebre, astenia, mialgia y soplo por mixoma cardíaco.

Cardiac tumours are rare, especially in children, and most of them are benign. Myxomas are unusual in children, being more common among adults. They are usually located in the left atrium, with 25% appearing in the right. The clinical signs and symptoms depend mainly on where the tumour is located. A feature of these tumours is that they can be accompanied by constitutional symptoms and laboratory abnormalities. Echocardiography is the study of choice, and a prompt resection is required to prevent serious complications. We present a case of a 10 year-old girl diagnosed with right atrial myxoma who presented with a fever, myalgia, asthenia and laboratory abnormalities. Diagnosis was made by echocardiography, and the early surgical resection of the tumour ran smoothly and showed a good postoperative recovery.