ABSTRACT
BACKGROUND: Analysis of the causes of death in children in the pediatric emergency department (ED) may aid the development of management and prevention practices. OBJECTIVE: To identify the causes of death in Spanish pediatric EDs and to analyze the management of these children in the prehospital and hospital settings. METHODS: This was a retrospective descriptive multicenter survey including all patients whose death was certified in 18 Spanish pediatric EDs between 2008 and 2013. RESULTS: During the study period, 3 542 426 episodes were registered in the EDs. Of these, 54 patients died (mortality rate: 1.5/100 000 visits). Data of 53 patients are analyzed (male 36, 67%, 31 younger than 2 years old and 43.3% nonpreviously healthy children). The main causes of death were related to their previous illnesses (24.5%), sudden infant death syndrome (20.7%), and traumatism (18.8%).Prehospital cardiopulmonary resuscitation (CPR) was performed in 31 patients, and exclusively by health workers in 19 patients. In 35 patients, the parents witnessed the event and seven began CPR.Thirty children were transferred to the pediatric EDs by medical transport (56.6%) and all of them received prehospital CPR (vs. one patient out of 23 arrived in a nonmedical transportation).In 37 patients, CPR was performed in the pediatric EDs. Overall, CPR lasted 40±23 min (range, 10-120 min). CPR was not performed in seven patients at any time. CONCLUSION: The main causes of death in Spanish pediatric EDs are related to previous illnesses, sudden infant death syndrome, and nonintentional lesions. Several actions have to be considered to improve the quality of care of these children in prehospital and emergency settings.
Subject(s)
Cause of Death , Emergency Medical Services/methods , Emergency Service, Hospital/statistics & numerical data , Hospital Mortality , Child, Preschool , Cross-Sectional Studies , Female , Hospitals, Pediatric , Humans , Infant , Male , Pediatrics , Retrospective Studies , Risk Assessment , SpainABSTRACT
The unique physical properties of optical coherence tomography (OCT) make it a useful technique in the study of restenosis mechanisms. In fact, OCT is able to differentiate between neointimal proliferation and neoatherosclerosis within the stent. We report a rare case of occlusive neoatherosclerosis presenting beyond one year after a successful drug-eluting stent implantation. The impact of OCT findings in the clinical decision making process is emphasized.
Subject(s)
Coronary Artery Disease/therapy , Coronary Occlusion/etiology , Coronary Restenosis/etiology , Coronary Vessels/diagnostic imaging , Hypolipidemic Agents/therapeutic use , Percutaneous Coronary Intervention/instrumentation , Plaque, Atherosclerotic , Stents , Aged , Cardiovascular Agents/administration & dosage , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Occlusion/diagnostic imaging , Coronary Occlusion/therapy , Coronary Restenosis/diagnostic imaging , Coronary Restenosis/therapy , Drug-Eluting Stents , Humans , Male , Percutaneous Coronary Intervention/adverse effects , Retreatment , Sirolimus/administration & dosage , Sirolimus/analogs & derivatives , Time Factors , Tomography, Optical Coherence , Treatment OutcomeABSTRACT
We performed a 7-year registry-based retrospective study. We included 1365 infants younger than 3 months of age with fever without a source; 81 (5.9%) had <5000 leukocytes/mm(3). Among the 1021 well-appearing 29- to 90-day-old infants, prevalence of serious bacterial infection (SBI) was 13.8% for those with a normal white blood cell count, 6.8% for those with leukopenia (odds ratio, 0.45), and 36.6% for those with leukocytosis (odds ratio, 3.59). None of the 9 well-appearing febrile neonates with leukopenia developed an SBI. Leukopenia, in well-appearing young febrile infants, should not be considered as an SBI risk factor.
Subject(s)
Bacterial Infections/diagnosis , Bacterial Infections/epidemiology , Fever/epidemiology , Leukopenia/epidemiology , Bacterial Infections/blood , Bacterial Infections/microbiology , Cross-Sectional Studies , Escherichia coli Infections/diagnosis , Escherichia coli Infections/epidemiology , Escherichia coli Infections/microbiology , Fever/etiology , Humans , Infant, Newborn , Leukocyte Count , Leukocytosis/blood , Leukocytosis/diagnosis , Leukocytosis/epidemiology , Leukopenia/blood , Leukopenia/diagnosis , Prevalence , Risk Factors , Streptococcal Infections/diagnosis , Streptococcal Infections/epidemiology , Streptococcal Infections/microbiologyABSTRACT
We analyzed 239 febrile infants <3 months of age with a positive urine culture to examine their characteristics. Patients with altered urine dipstick showed more commonly alterations of the biologic markers for bacterial infection, and Escherichia coli was more commonly isolated. Febrile young infants with positive urine culture and negative urine dipstick may not have a urinary tract infection and less aggressive management can be considered.
