Prospective validation of two systems of classification for the diagnosis of acute appendicitis.

OBJECTIVES: The objectives of this study were (1) to validate the Alvarado score and pediatric appendicitis score (PAS) in a prospectively identified pediatric cohort and (2) to assess abdominal ultrasonography (AUS) as a tool to increase the diagnostic reliability of both scores. PATIENTS AND METHODS: Prospective study conducted from January 10, 2008, to January 1, 2009. All patients attended at the emergency department with suspected acute appendicitis (AA) who had a blood sample collected were included. Items from both scores were recorded. The performance of an AUS, the decision to admit the patient, and the therapeutics were decided by the physician, disregarding the scores values. Nonadmitted patients were contacted by telephone. RESULTS: Ninety-nine patients were included. Mean age was 11 years, and 62.6% were males. Appendectomy was performed in 44.4% patients. The area under the receiver operating characteristic curve for the Alvarado score was 0.96 and that for PAS was 0.97. Not a single patient with an Alvarado score less than 5 or PAS less than 4 had AA. All patients with an Alvarado score greater than 8 or PAS greater than 7 had AA. For both scores, the optimum cutoff point was 6 (sensibility of 90.4% and specificity of 91.2% for the Alvarado score and sensibility of 88.1% and specificity of 98.2% for PAS). Abdominal ultrasonography was performed on 31 patients (sensibility of 84.6% and specificity of 94.4%). We studied the value of scores and AUS together. Assuming an Alvarado score from 1 to 4 and PAS from 1 to 3 as no AA, an Alvarado score from 9 to 10 and PAS from 8 to 9 as AA, and proceeding according to the AUS for intermediate values, a sensibility of 93.3% and 97.2% and a specificity of 100% and 97.6%, respectively, were obtained. CONCLUSIONS: Both scores are a useful tool in the evaluation of children with possible AA. For extreme values of scores, the results really ensure their use in the emergency department. The AUS can help on decision making for intermediate values.

Mastoïditis aguda: estudi clínic i microbiològic de 116 casos / No disponible

Objectiu. Estudi de les característiques clíniques i microbiològiques de les mastoïditis agudes al nostre medi. Investigació de la influència de l'ús i l'abús d'antibiòtics en l'otitis mitjana en la freqüència i la gravetat de les mastoïditis.Mètode. Estudi retrospectiu de 116 casos de mastoïditisaguda diagnosticats a l'Hospital Sant Joan de Déu durantun període de 5 anys (1996-2000).Resultats. La mitjana d'edat va ser d'1.8 anys, amb unrang de 2 mesos a 15 anys d'edat (56 % de sexe masculí).La incidència va ser més gran els darrers 2 anys. El 61% presentaven otitis mitjana aguda i el 62% estaven rebentantibiòtic. Noranta set nens presentaven eritema i edemaretroauricular, 90 desplaçament del pavelló auricular i 84 febre. Es va fer hemocultiu a 65 pacients (positiu en 3 casos) i cultiu de secreció òtica a 58 (positiu en 25 pacients). El germen aïllat més sovint va ser el pneumococ (14 casos), principalment els serotips 6B i 19. El percentatge d'aïllament bacterià va ser més alt en pacients no tractats prèviament (52%) que en pacients tractats (36.4%). Les cefalosporines van ser el tractament d'elecció en 105 pacients. Es va fer miringotomia en 48 pacients. Van requerir mastoidectomia 11 pacients. Les mastoïditis més greus es van observar en pacients amb tractament antibiòtic previ.Conclusions. La incidència de mastoïditis aguda estàaugmentant al nostre medi i en aquest estudi són més greus en pacients tractats prèviament. El pneumococ és el principal microorganisme implicat i la majoria de soques estan incloses a la vacuna heptavalent. En tots els casos de mastoïditis aguda s'hauria de fer miringotomia per tal de poder obtenir el microorganisme implicat i el seu antibiograma

No disponible

Análisis de los motives de derivación a un servicio de urgencias pediátricas / Analysis of the reasons for referral to a pediatric emergency department

Objetivo. Revisar los motivos y las características de las derivaciones de pacientes a un Servicio de Urgencias Pediátricas de un hospital de tercer nivel Método. Estudio retrospectivo de los informes de derivaciones y de los informes de urgencias de 250 pacientes remitidos a nuestro centro en un período de 15 días del mes de abril de 2001. Se considera idónea la derivación de los casos que se tratan de una urgencia hospitalaria (emergencia vital o necesidad de utilización de medios diagnósticos o terapéuticos no disponibles en Atención Primaria). Resultados. El 40% de los niños derivados son menores de 2 años, y el 31% tienen entre 2 y 6 años. Predomina el sexo masculino (57.2%). El 74 % son derivados por su médico habitual. Los motivos más frecuentes de derivación son la solicitud de exploraciones complementarias (24.4%) y la presencia de fiebre (14.4%). En el 58.8% de los casos consta orientación diagnóstica del médico que efectúa la derivación. Al 90% de los pacientes derivados se les realiza lo que se solicitaba. La derivación se consideró adecuada en el 74.8% de los casos, aunque un 50% de éstas podían haberse solucionado en los centros emisores. El porcentaje de adecuación aumenta al 83.5% si la derivación es realizada por el pediatra habitual (p<0.05). Conclusiones. Un motivo importante de derivación es la realización de exploraciones complementarias. Existe un buen criterio a la hora de derivar. La remisión por parte de los facultativos no pediatras y por los pediatras no habituales del paciente disminuye la adecuación de la derivación (AU)

Objective. To review the reasons and characteristics of the referrals made to the pediatric emergency department of a third-level hospital. Method. Retrospective study of the referral information and the clinical records of 250 patients that were sent to our centre during a 15-day period in the moth of April of 2001. The referral was considered appropriate if it was a hospital emergency (defined as vital emergency or need for therapeutic or diagnostic procedures not available in primary care). Results. Forty percent of the referred children were younger than 2 years of age, and 31% were between 2 and 6 years of age. There was a slight male predominance (57.2%). Seventy-four percent of the patients were referred by their primary physician. The most frequent reasons for referral were the request for diagnostic procedures (24.4%) and the presence of fever (14.4%). A preliminary diagnosis was specified by the referring physician in 58.8% of the cases. In 90% of the referred patients, the tests requested were performed by the emergency department. The referral was considered appropriate in 74.8% of the cases, although 50% of the patients could have been managed by the referring centres. The percentage of referral adequacy increases to 83.5% if the referral is made by the primary physician (p<0.05). Conclusions. An important reason for referral is the request for a diagnostic procedure. The reasons for referral are appropriate in most cases. The referrals made by health-care workers other than pediatricians, and those made by non-primary pediatricians are less adequate (AU)