[Diagnostic yield of abdominal ultrasonography in acute appendicitis]. / Rendimiento de la ecografía abdominal en el diagnóstico de apendicitis aguda.

INTRODUCTION: Acute appendicitis (AA) is the first cause of surgical abdomen in childhood but diagnosis continues to be difficult in some cases. Abdominal ultrasonography has been shown to be useful when there is doubt about the diagnosis and can be quickly and easily performed at the patient's bedside. OBJECTIVE: To evaluate the efficacy of abdominal ultrasonography in the diagnosis of acute appendicitis in our hospital. PATIENTS AND METHODS: All patients who visited the emergency department for abdominal pain and who underwent abdominal ultrasonography to rule out AA between January 1, 1999 and December 31, 2000 were retrospectively studied. RESULTS: During the study period, 4217 children were evaluated in our service for abdominal pain. Ultrasonography was performed in 528 children. Of these, the procedure was performed to rule out AA in 308 patients. Of these 308 patients who met the study's inclusion criteria, the results of ultrasonography were compatible with AA in 102 and were normal in 196. Ultrasonographic diagnosis differed from the final diagnosis in 16 patients. In eight children with ultrasonographic findings suggestive of AA, laparotomy revealed normal appendices. In the remaining eight patients, ultrasonographic findings were normal and surgery revealed AA. Based on these findings, the diagnostic yield of abdominal ultrasonography was: sensitivity: 96.6 %; specificity: 95.9 %, positive predictive value: 86 %; negative predictive value: 95.9 %. CONCLUSIONS: The overall diagnostic yield of abdominal ultrasonography in AA our hospital is acceptable. Because ultrasonographic diagnosis is not always accurate, others diagnostic methods such as computed tomography should be used in doubtful cases.

Rendimiento de la ecografía abdominal en el diagnóstico de apendicitis aguda / Diagnosticyield of abdominal ultrasonography in acute appendicitis

Introducción. Aunque la apendicitis aguda es la primera causa de abdomen agudo en la infancia, el diagnóstico continúa siendo difícil en algunas ocasiones. En los casos en que existan dudas diagnósticas la ecografía abdominal es una herramienta útil, de rápida realización y accesible en la cabecera del enfermo. Objetivo. Evaluar la eficacia en nuestro medio de la ecografía abdominal para el diagnóstico de apendicitis aguda. Pacientes y métodos. Estudio retrospectivo, entre el 1 de enero de 1999 y el 31 de diciembre de 2000, de todas las consultas en el servicio de urgencias por dolor abdominal indicativo de abdomen agudo, en los que se realizó una ecografía abdominal para descartar apendicitis aguda. Resultados. Consultaron en nuestro servicio 4.217 niños por dolor abdominal. Se realizó ecografía en 528 niños. De éstos, en 308 niños la exploración ecográfica se llevó a cabo para descartar el diagnóstico de apendicitis aguda. De los 308 pacientes que reunieron los criterios de inclusión en el estudio, en 112 ocasiones la ecografía fue indicativa de apendicitis aguda y en 196, normal. En 16 pacientes el diagnóstico ecográfico fue discordante con el diagnóstico final. En 8 pacientes el informe ecográfico de apendicitis y laparotomía en blanco. Los otros 8 niños restantes con ecografía informada como normal y diagnóstico quirúrgico de apendicitis aguda. Con estos datos, el rendimiento global de la ecografía para el diagnóstico de apendicitis aguda que se obtuvo en el presente estudio se tradujo en una sensibilidad del 96,6 por ciento, especificidad del 95,9 por ciento, un valor predictivo positivo del 86 por ciento y un valor predictivo negativo del 95,9 por ciento. Conclusiones. El rendimiento global de la ecografía abdominal para el diagnóstico de apendicitis aguda en nuestro medio es aceptable. La presencia de falsos positivos y negativos, aunque mínima, obliga a valorar la utilización de otras pruebas diagnósticas (tomografía computarizada) en los casos dudosos (AU)

[Emergency department visits for poisoning: epidemiological changes in the last 10 years]. / Intoxicaciones en urgencias: cambios epidemiológicos en los últimos 10 años.

OBJECTIVE: To study the epidemiological changes observed in pediatric poisonings treated in our Emergency Department between 1988 and 1999. PATIENTS AND METHODS: Descriptive, observational study performed in three 12-month periods (1988, 1993 and 1999). The circumstances surrounding the visit, treatment in the Emergency Department and clinical evolution were registered. RESULTS: Consultations for possible poisoning decreased between 1988 and 1999 (279 vs. 161, p 0). This decrease was noted both in poisonings caused by household products (91 vs. 48, -47 %) and those caused by drugs (112 vs. 87, -22 %). Antipyretics caused one-third of drug poisonings and psychotropics caused approximately 11 %. The most commonly implicated agent is currently paracetamol. Caustic alkali were the most common household products causing poisoning although the number of such poisonings decreased (48 episodes in 1988 and 18 in 1999). Hydrocarbons were the second most frequent cause of household product poisoning (12-16/year). Most episodes occurred at home. The poison, mainly household products, was kept in a container other than the original in nearly 5 % of episodes in 1988 and in 13.7 % in 1999. The number of children receiving treatment in the Emergency Department decreased between 1988 and 1993 and remained stable between 1993 and 1999 (62 % in 1988 and approximately 35 % in 1993 and 1999; p 0.000003). The number of admissions also decreased from 17 children in 1989 (6.0 %) to six in 1999 (3.7 %, p 0.39). No deaths were recorded. CONCLUSIONS: In the last ten years, visits for possible episodes of pediatric poisoning have decreased, mainly those due to mild poisoning caused by household products. Paracetamol has replaced acetyl-salicylic acid as the most frequently implicated drug.

Intoxicaciones en urgencias: cambios epidemiológicos en los últimos 10 años / Emergency department visits for poisoning: epidemiological changes in the last 10 years

Estudiar los aspectos epidemiológicos de las intoxicaciones atendidas en urgencias de pediatría entre 1988 y 1999.Pacientes y métodos Estudio descriptivo, observacional, desarrollado en tres fases de 12 meses (años 1988, 1993 y 1999). Se registraron las circunstancias que rodearon la consulta, el tratamiento en urgencias y la evolución clínica. Resultados Las consultas por posible intoxicación han descendido entre 1988 y 1999 (279 frente a 161, p 0), tanto las debidas a productos del hogar (IPH) (91 frente a 48, -47 por ciento) como las medicamentosas (IM) (112 frente a 87, -22 por ciento).Los antitérmicos constituyen un tercio de las IM y los psicofármacos alrededor del 11 por ciento. El paracetamol es actualmente el fármaco más implicado. Los álcalis-cáusticos constituyen la IPH más frecuente, aunque su número se ha reducido (48 en 1988 y 18 en 1999). Los hidrocarburos suponen la 2.ª IPH (número estable, 12-16/año).La intoxicación suele darse en el hogar propio. El tóxico estaba guardado en un recipiente no original en cerca del 5 por ciento en 1988 y en el 13,7 por ciento en 1999, básicamente productos del hogar. El número de pacientes que recibe tratamiento en urgencias ha descendido entre 1988 y 1993 y permanece estable entre 1993 y 1999 (62 por ciento en 1988 y alrededor del 35 por ciento en 1993 y 1999; p 0,000003). El número de ingresos ha descendido de 17 (6,0 por ciento) a 6 (3,7 por ciento, p 0,39).No se registraron fallecimientos. Conclusiones En los últimos 10 años han descendido las consultas por posible intoxicación en niños basándose en las intoxicaciones menores, principalmente por productos del hogar. El paracetamol ha desbancado al ácido acetilsalicílico como fármaco más frecuentemente implicado (AU)

Methemoglobinemia and consumption of vegetables in infants.

OBJECTIVE: To assess clinical and epidemiologic data of 7 infants diagnosed with acquired methemoglobinemia at the pediatric emergency department between 1993 and 1998. All cases were attributed to the consumption of mixed vegetables. METHODS: Medical records were reviewed to collect anamnestic data; history of food ingestion; and results of physical examination, pulse oximetry, gasometry, cooximetry, urinalysis, and outcome. Local health authorities provided information on nitrate concentration in running water and in vegetables of common consumption in the area. RESULTS: The mean age of the patients was 8.14 months (range: 7-13). None of the infants was undernourished, had diarrhea, or was given any drug. Drinking water showed a nitrate concentration of 3 to 6 ppm. All were fed homemade purée of mixed vegetables, prepared in advance and kept in the refrigerator for 12 to 27 hours. Silver beets were a common ingredient. No case showed metabolic acidosis. Methemoglobin level ranged between 10% and 58%. Three cases had nitrituria. Silver beets in our area were the vegetables with the highest nitrate concentration (mean: 3200 mg/kg). CONCLUSIONS: Consumption of silver beets and incorrect storage of homemade purées of mixed vegetables were potential causes of methemoglobinemia in this series. The disease may occur in children older than 6 months of age. Nitrituria in a cyanotic infant may suggest the diagnosis of methemoglobinemia.methemoglobinemia, nitrates, nitrites, food analysis, infant food, food preservation.

[Use of a hospital pediatric emergency department during the night]. / Utilización nocturna de una unidad de urgencias pediátrica hospitalaria.

OBJECTIVE: To determine the characteristics of children younger than 14 years visiting our pediatric emergency department between 0:00 and 8:00 hours. PATIENTS AND METHODS: Retrospective review of 300 children visiting our emergency department at night. RESULTS: Between March 1 and 22 1999 we recorded 300 episodes from 0:00-8:00 hours (1.7 patients/hour) and 2350 episodes from 8:00-24:00 hours (6. 6 patients/hour). Of the 300 episodes registered at night, 132 children (44%) came between 0:00 and 2:00. The most common complaints were: respiratory symptoms in 116 patients (38.6%), fever in 61 (20.3%) and digestive symptoms in 61 (20.3%). We carried out at least one complementary test in 111 patients (37.0%). Five children (1.7%) were admitted to the hospital (80 between 8:00 and 24:00, 3.4%, p = 0.15) and 25 (8.3%) were admitted for a few hours to the observation ward (123 of the 2350 who came between 8:00 and 24:00, 5.2%, p = 0.06). Final diagnoses were: ear nose and throat infection in 91 (30.3%), fever without source in 38 (12.6%), asthma in 29 (9.6%), acute gastroenteritis in 27 (9%), croup in 22 (7.3%), vomiting in 14 (4.6%), abdominal pain in 13 (4.3%), febrile convulsion in 6 (2%), pneumonia in 5 (1.6%), bronchiolitis in 5 (1. 6%), bacteremia in 1 (0.3%), and other diagnoses in 46 (16.3%). CONCLUSIONS: The number of visits to our emergency department diminished at night, particularly between 0:00 and 2:00. The night-time admission rate was less than the daytime rate, although this difference was not statistically significant. Admission for a few hours to the observation ward was more common at night. The percentage of patients with respiratory illnesses was higher during the night.

[Children's unscheduled return visits to an emergency department]. / Los niños que repiten consulta en urgencias de pediatría.

OBJECTIVE: To study the patients who make unscheduled return vi-sits in less than week to a pediatric emergency department (ED). PATIENTS AND METHOD: Retrospective review of 495 episodes in 233 children who were attended at our ED in November 1999. RESULTS: In November 1999, we registered 3667 episodes at our ED (495 corresponding to 233 children who made repeat visits, 13.4%). The most common chief complaints among children who revisited were fever and respiratory symptoms. The most common diagnoses were fever with-out apparent source, ORL infections, asthma and acute gastro-enteritis. The diagnoses made at the initial and fi-nal visits were the same in 131 cases (56.2%), a complication was detected in 18 (7.7%) and 84 (36.1%) were given a different diagnosis. The percentage of patients who received a symptomatic diagnosis was lower in the final visit. The admission rate of children who revisited was higher than that of children who visited our ED once (6.4% vs. 3.0%, p = 0.009), caused by the group of patients who received a different diagnosis when they revisited our ED. CONCLUSIONS: Patients who revisit a pediatric ED within a week are more likely to be admitted to the hospital, especially if the diagnosis they receive varies.

Eficacia de la administración precoz de bromuro de ipratropio nebulizado en niños con crisis asmática / Efficacy of early administration of nebulized ipratropium bromide in children with acute asthma attack

OBJETIVO: Determinar la eficacia de la administración conjunta de bromuro de ipratropio y salbutamol nebulizado en el tratamiento de las crisis asmáticas moderadas-severas de los niños. MÉTODOS: Se estudiaron 102 pacientes con edades comprendidas entre 5 meses y 16 años, asignándoles, de forma aleatoria y doble ciego, a 2 grupos. Todos los pacientes recibieron tratamiento con salbutamol nebulizado, 0,2 mg/kg y corticoides por vía oral, 1 mg/kg. El grupo A recibió 2 dosis de bromuro de ipratropio nebulizado (250 mg/dosis) y el grupo B placebo. Antes de iniciar el tratamiento y a los 120 minutos, se valoró por escala clínica (frecuencia cardíaca, frecuencia respiratoria, disnea, retracciones y sibilancias) puntuándola de 0 a 5 y la saturación de oxígeno. RESULTADOS: Basalmente, no se observaron diferencias en la puntuación de la escala clínica (grupo A: A total of 102 patients aged between 5 months and 4,45; grupo B: 4,43) ni en la saturación de oxígeno (grupo A: 93,05 por ciento, grupo B: 92,78 por ciento). A los 120 minutos de iniciado el estudio, tampoco se observaron diferencias significativas entre ambos grupos de estudio: escala clínica (grupo A: 2,45; grupo B: 2,74) y saturación de oxígeno (grupo A: 94,33 por ciento; grupo B: 94,03 por ciento). El porcentaje de ingresos fue inferior en el grupo A (35 por ciento) que en el grupo B (53 por ciento) (p = 0,07). En los pacientes con crisis más graves (escala inicial = 5), tanto la puntuación de la escala clínica tras el tratamiento (grupo A: 2,69; grupo B: 3,32), como el porcentaje de ingresos (grupo A: 39 por ciento; grupo B: 73 por ciento) resultaron significativamente inferiores en el grupo A (p < 0,05). CONCLUSIÓN: La administración de bromuro de ipratropio combinado a dosis repetidas de salbutamol nebulizado tiene un efecto clínico beneficioso muy discreto en relación con los niños que reciben únicamente salbutamol. Este efecto beneficioso se traduce en una reducción en las tasas de ingreso, sobre todo en los pacientes más graves (AU)

Los niños que repiten consulta en urgencias de pediatría / Children´s unscheduled return visits to an emergency department

Scanear (AU)

Tratamiento extrahospitalario de los niños con meningitis viral / Outpatient management of children with viral meningitis

OBJETIVO: Describir nuestra experiencia en el tratamiento extrahospitalario de los niños con sospecha de meningitis viral. PACIENTES Y MÉTODOS: Entre abril y julio de 1997, 156 niños fueron diagnosticados de meningitis viral en nuestro hospital. De éstos, 150 fueron tratados ambulatoriamente con reposo y analgésicos, tras permanecer unas horas en la unidad de observación de urgencias. En todos los casos se practicó examen citoquímico y tinción de Gram del líquido cefalorraquídeo (LCR), hemograma completo y proteína C reactiva sérica, hemocultivo y cultivo del LCR para bacterias y virus. La evolución del proceso se controló mediante contacto telefónico. RESULTADOS: Todos los cultivos bacterianos practicados en sangre y LCR fueron negativos y la evolución clínica de los pacientes fue favorable. En el control telefónico posterior 104 niños (69,3 por ciento) refirieron síntomas transitorios como cefalea o molestias radiculares. De éstos últimos, 20 niños (13,3 por ciento de los 150) volvieron a consultar en nuestro servicio de urgencias, por persistencia de los síntomas o molestias radiculares, precisando 4 de ellos el ingreso en la unidad de observación durante unas horas (4-12 h). Tras el alta de urgencias, los niños faltaron al colegio una media de 5,9 ñ 6,1 días (rango, 1-30 días), y 71 (47,3 por ciento) faltaron menos de 3 días. CONCLUSIÓN: El tratamiento y seguimiento de gran parte de los niños con meningitis viral puede hacerse sin necesidad de ingreso hospitalario. En el momento del alta, es preciso dar a la familia instrucciones detalladas sobre la evolución del proceso (AU)

Utilización nocturna de una unidad de urgencias pediátrica hospitalaria / Utilisation of a hospital pediatric emergency department during the night

OBJETIVO: Conocer las características de los pacientes que acuden a urgencias de pediatría de las 0 a las 8 h. PACIENTES Y MÉTODOS: Estudio retrospectivo de 300 niños atendidos por la noche en urgencias. RESULTADOS: Entre el 1 y el 22 de marzo de 1999 se registraron 300 episodios de 0 a 8 h (1,7 pacientes/h) y 2.350 de las 8 a las 24 h (6,6 pacientes/h).De los 300 episodios nocturnos, 132 correspondían a niños que acudieron de entre las 0.00 a las 2.00 h (44 por ciento). Los motivos de consulta más frecuentes fueron: síntomas respiratorios, 116 (38,6 por ciento); digestivos, 61 (20,3 por ciento), y fiebre 61 (20,3 por ciento), practicándose alguna exploración complementaria a 111 pacientes (37,0 por ciento). Ingresaron 5 niños (1,7 por ciento) de los que se presentaron entre las 0 y las 8 h, y 80 (3,4 por ciento) de los que acudieron entre las 8 y las 24 h, (p = 0,15), mientras 25 (8,3 por ciento) permanecieron unas horas en la unidad de observación (123 de 8 a 24 h, 5,2 por ciento; p = 0,04). Los diagnósticos fueron: infección otorrinolaringológica 91 (30,3 por ciento); fiebre sin foco, 38 (12,6 por ciento); asma, 29 (9,6 por ciento); gastroenteritis aguda, 27 (9 por ciento); laringitis, 22 (7,3 por ciento); vómitos 14 (4,6 por ciento); dolor abdominal, 13 (4,3 por ciento); convulsión febril, 6 (2 por ciento); neumonía, 5 (1,6 por ciento); bronquiolitis 5 (1,6 por ciento); bacteriemia, 1 (0,3 por ciento), y otros, 49 (16,3 por ciento). CONCLUSIÓN: La presión asistencial en urgencias de pediatría disminuye por la noche, especialmente de 2 a 8 h. La tasa de ingresos nocturna es menor a la diurna, sin que la diferencia sea estadísticamente significativa, existiendo una mayor tendencia a dejar más pacientes en la unidad de evolución. El porcentaje de pacientes con enfermedad respiratoria se incrementa por la noche (AU)

[Outpatient management of children with viral meningitis]. / Tratamiento extrahospitalario de los niños con meningitis viral.

OBJECTIVE: To describe our experience in the extrahospitalary management of children with suspected viral meningitis (YM). METHOD: Between April and July 1997. 156 children were diagnosed of YM in our hospital and 150 managed as outpatients, after being a few hours in our emergency department. All of them were suspected to have VM attending usual clinical and laboratory findings and were discharged with cautious instructions to demand a new assessment. We contacted telephonically with them one month and six months later. RESULTS: All the children with suspected viral meningitis and managed as outpatients had negative blood and CSF cultures and all of them did well. Telephonically, 104 children (69.3%) referred transient headache or back pain. and 20 of these (13.3% of all the 150) came again to our hospital, and 4 required rest for a few hours (4-12 hours) in our observation setting. Children with suspected VM didn't go to school during 5.9 x 6.1 days (1-30 days) and 71 (47.3%) were absent less than 3 days. CONCLUSION: Outpatient management of most of the children with suspected VM is possible. When a patient is sent home, detailed instructions must be given to the family.

[Lumbar puncture in a pediatric emergency department: something more than a diagnostic technic]. / Punción lumbar en Urgencias de Pediatría: algo más que una técnica diagnóstica.

OBJECTIVE: The aim of this study was to know the incidence of serious bacterial infections (SBI) in children without sepsis or intracranial infection in which spinal puncture (LP) was performed in an Emergency Department. PATIENTS AND METHODS: A retrospective study of all 471 previously healthy children between 1 month and 14 years of age in which a lumbar puncture was performed between July 1995 and March 1997 in the Emergency Department of our hospital was performed. RESULTS: Two hundred and three children (43%) had sepsis, meningitis or encephalitis (aseptic meningitis 149, 31.6%; sepsis-bacterial meningitis 26, 5.5%; nonspecific meningitis 26, 5.5%; encephalitis 2, 0.4%) and 14 (5.2%) had pneumonia. Of the other 254 children, 36 (14.1%) had a SBI: 19 urinary tract infections (E. coli), 11 bacteremia (Streptococcus pneumoniae 8, Salmonella enteritidis 1, Proteus mirabilis 1, E. coli 1, the latter two also having a positive urine culture) and 6 bacterial gastroenteritis (salmonella 5, Campylobacter jejuni 1). The incidence of SBI was significantly higher in the group of children younger than 5 years old (32/175, 18.2%) than in the older group (4/79, 5.0%, p = 0.009). Two patients died (one with pneumococcal meningitis and one with meningococcal sepsis). CONCLUSIONS: Children with fever and a normal result in the LP must be carefully examined and, especially in younger patients, urine, blood and stool (if stool abnormalities) cultures should be collected. These children must be closely observed in the hospital or at home and must be re-evaluated by their pediatrician in the following 24 hours.

[Diagnostic value of reactive C protein in suspected acute appendicitis in children]. / Valor diagnóstico de la proteína C reactiva en las sospechas de apendicitis aguda en la infancia.

OBJECTIVE: The aim of this study was to evaluate the accuracy of C-reactive protein (CRP) measurements in the diagnosis of suspected acute appendicitis (AA) during childhood. PATIENTS AND METHODS: A prospective study of 195 consecutive children, aged between 2 and 14 years and suspected of having AA, that attended a pediatric emergency room was carried out. We obtained a careful patient history, physical signs, blood test results, final diagnosis and the histological findings in the cases who underwent appendectomy (classified as normal appendix, simple appendicitis (SA) or gangrenous appendicitis (GA). RESULTS: The final diagnoses and their frequencies were: AA (94), non-specific abdominal pain (80), mesenteric lymphadenitis (6) and others (15). Appendectomies were performed in 103 cases with 94 cases being AA (91.3%) and of these 51 SA and 43 GA. The average values of CRP (mg/l) were: AA: 30, SA: 16, GA: 67, non-specific abdominal pain: 15, and mesenteric lymphadenitis: 44 (p < 0.01). The values of AG were statistically higher than those of SA (p = 0.0000). The ROC curve of these data determined the best cut-off levels for AA to be 30 (sensitivity: 0.43, specificity: 0.92, predictive value of a positive result: 0.87 and predictive value of a negative result: 0.58). CONCLUSIONS: 1) The value of CRP in AA is higher than in other abdominal pain etiologies. Nevertheless, this value should not be used to deny surgery since it is often normal in SA. 2) When a CRP value > 40 mg/L is found in a suspected AA, one should think about GA and therefore, initiate prophylactic antibiotics and perform surgery immediately.

[Head injuries in children: can clinical features identify patients with high or low risk for intracranial injury?]. / Traumatismo craneal en la infancia: permite la clínica seleccionar los pacientes en alto o bajo riesgo de presentar una lesión intracraneal?

OBJECTIVE: The objective of this study was to assess the clinical features that might reliably identify the presence of an intracranial injury. PATIENTS AND METHODS: A prospective study of 1,128 children with head injury over a one year period was carried out. Information regarding each patient was documented, including demographic data, physical examination findings, neurologic status, diagnostic studies and the patient's outcome. RESULTS: Of the 1.128 patients, traumatic intracranial abnormalities identified on CT of the head was found in 11 (1%). Four patients of this group (36%) required surgery. Two children subsequently died. Loss of consciousness, amnesia. Glasgow Coma Scale less than 15 and focal neurological deficits were significantly more common in the group with intacranial injury. The negative predictive values were high for all features. CONCLUSIONS: Patients with symptoms of head injury should undergo head CT because a small number will require surgery. After a minor head trauma, children who are neurologically normal and without symptoms may be discharged from the emergency department and sent home after careful physical examination alone.

[Recent changes in emergency room visits and hospitalization for asthma in childhood]. / Cambios recientes en la frecuentación a urgencias y hospitalización por asma en la infancia.

OBJECTIVE: The purpose of this study was to investigate recent changes in the emergency room visits and hospital admission rates between 1993 and 1997 in our hospital. PATIENTS AND METHODS: From January 1, 1993 until December 31, 1997, the 12,848 patients between 0 and 14 years of age whose discharge diagnosis was coded as asthma (ICD9) and who were managed in the emergency room of our hospital were included in the study. RESULTS: During the study period, the number of emergency room visits for asthma (EA) remained unchanged. However, in children between 0 and 5 years of age the number of EA showed a significant increase from 1305 in 1993 (53.5% of all EA) to 1849 in 1997 (68.9% of EA), with an increase of the repeat visits in this age group from 46 (35.8% of all EA in this age group) in 1993 to 791 (42.8%) in 1997 (p < 0.01). In the same period of time, the admission rates for asthma decrease from 7.2% to 2.9% (p < 0.01). There was a trend towards more intense treatment of asthma in the emergency observation unit. CONCLUSIONS: There has been an upward trend in the number of acute asthma episodes between 1993 and 1997 in children between 0 and 5 years of age. It was associated with an increase in the number of repeat visits per patient. The use of a more intense treatment in the emergency observation unit was associated with a reduction in the hospitalization rate for asthma.