[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.

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

Scanear (AU)

[Clinical and epidemiological spectrum of Mycoplasma pneumoniae infections at a pediatric hospital]. / Espectro clínico-epidemiológico de las infecciones por Mycoplasma pneumoniae en un hospital infantil.

OBJECTIVE: The objective of this study was to determine the epidemiology of Mycoplasma pneumoniae infections at our hospital and to evaluate the prescription of macrolides to empirically treat respiratory infections in children. PATIENTS AND METHODS: A one year prospective study was performed. To find out the prevalence of M. pneumoniae infections, we obtained blood samples of 519 children attending our hospital out-patient department to determine M. pneumoniae IgG levels. In order to establish the incidence, IgM antibodies against M. pneumoniae were measured in 255 children admitted to the hospital showing clinical pictures compatible with this infection. RESULTS: In the first years of life, prevalence of M. pneumoniae infection was low. According to our study, only 3.3% of 1 year-old patients had M. pneumoniae antibodies. Antibody levels increased in children of 5 years or older. The highest rates, between 58.5% and 63.3%, were detected in patients between 8 and 12 years of age. The incidence rate (6.7%) was low among the children admitted. The most frequent clinical entity was pneumonia (82%). The highest rate of infection was found in children of 8 to 10 years. Symtomatology was mainly sub-acute. Crioagglutinins provided the most significant predictive value for etiological diagnosis. CONCLUSIONS: M. pneumoniae infections gain significance in patients over 5 years of age. In our environment, incidence of acute symptomatic infection is low. We consider that both age and presentation of acute respiratory processes should be taken into account when establishing empirical macrolide treatment in children.

[Usefulness of oxygen saturation in the assessment of children with moderated laryngitis]. / Utilidad de la saturación de oxígeno en la valoración del niño con laringitis moderada.

OBJECTIVE: The aim of this study was to determine the usefulness of oxygen saturation (SaO2) in the assessment of a child with moderate laryngitis (croup). PATIENTS AND METHODS: A prospective study was carried out on 54 cases of moderate laryngitis (score of 2 to 6 of a possible 16) attended at our emergency department. Clinical score, heart rate, respiratory rate and SaO2 were recorded upon arrival. We analyzed the relationship between SaO2 and the requirement of nebulized epinephrine, parenteral dexamethasone and admission to the hospital. RESULTS: Patients who received epinephrine showed SaO2 values lower than those who did not (96.8 +/- 1.9 vs 97.9 +/- 1.7), although this was not a significant difference (p = 0.11). Similar findings were seen when the requirement of parenteral dexamethasone was analyzed (96.7 +/- 1.9 vs 97.3 +/- 1.8, p = 0.28). Children admitted to the hospital showed SaO2 values significantly lower than those discharged (96.5 +/- 1.9 vs 97.6 +/- 1.7, p = 0.03). No differences were seen when heart rate or respiratory rate were analyzed. CONCLUSIONS: We conclude that the measurement of is SaO2 useful in initial assessment of a child with acute laryngitis, essentially in order to better identify those patients who require admission to the hospital. It appears reasonable to include it in the initial assessment score.