Crisis asmática en los servicios de urgencias en Espa˜na, ¿cuál es nuestra práctica habitual? / Asthma crisis in emergency departments in Spain: what is our usual practice?

Introducción: A pesar de la existencia de múltiples guías y documentos de consenso sobre el asma, persiste todavía una gran variabilidad en su abordaje, situación poco analizada en los Servicios de Urgencias (SU). Objetivo: Describir el manejo habitual de las crisis asmáticas en los SU españoles, conocer el grado de variabilidad entre sus diferentes profesionales y analizar los factores que pueden influir en su manejo. Material y métodos: Se elaboró un cuestionario, basado en supuestos clínicos, que se distribuyó entre los socios de la Sociedad Española de Urgencias de Pediatría y asistentes a la reunión en 2011. Resultados: Se analizan 300 encuestas. En 190 casos, el lugar de trabajo habitual es un hospital de tercer nivel. Existe una alta coincidencia en la valoración de la gravedad de los casos. Más del 90% utiliza beta 2 agonistas inhalados en la crisis asmática leve, el 75,3% utiliza corticoides orales en crisis moderadas y el 79% utiliza bromuro de ipratropio en las crisis graves. El 98% considera importante hacer educación terapéutica en los SU. Solo 8 (2,7%) utilizan la medición del pico de flujo espiratorio máximo. Los encuestados que trabajan en un hospital de tercer nivel utilizan con más frecuencia escalas de gravedad (90,5% vs. 80%, p = 0,009) y administran corticoides parenterales con menos frecuencia (53,2% vs. 66,4%, p = 0,017). Conclusiones: Aunque un porcentaje elevado de pediatras que trabajan en los SU siguen las guías de práctica clínica, se han detectado aspectos en los que el abordaje del asma es discordante entre los diferentes profesionales(AU)

Background: Despite there being various guidelines and consensus statements on asthma, great variability still exists in its treatment approach; although this has been little discussed in Emergency Departments (ED). Objective: To describe the usual management of asthma exacerbations in Spanish ED, and to determine the degree of variability among different professionals, as well as analyse factors that may influence their management. Material and methods: A questionnaire was developed based on clinical cases, which was distributed among members of the Spanish Society of Paediatric Emergencies and attendees at the meeting in 2011. Results: A total of 300 surveys were analysed. In 190 cases the place of work was in a tertiary care hospital. There was high agreement in the assessment of the severity of the cases mentioned. Over 90% use inhaled beta 2 agonists in mild asthma exacerbations, 75.3% used oral corticosteroids in moderate exacerbations, and 79% use ipratropium bromide in severe exacerbations. Almost all (98%) considered Therapeutic Education important in the Emergency Department. Only 8 (2.7%) used peak expiratory flow measurements. Respondents working in a tertiary hospital used severity scales more frequently (90.5% vs 80%, P=0.009) and administered parenteral corticosteroids less frequently (53.2% vs 66.4%, P=0.017). Conclusions: Although a high percentage of paediatricians working in the ED follow Clinical Practice Guidelines, some different points of the approach among professionals have been identified(AU)

[Asthma crisis in emergency departments in Spain: what is our usual practice?]. / Crisis asmática en los servicios de urgencias en España, ¿cuál es nuestra práctica habitual?

BACKGROUND: Despite there being various guidelines and consensus statements on asthma, great variability still exists in its treatment approach; although this has been little discussed in Emergency Departments (ED). OBJECTIVE: To describe the usual management of asthma exacerbations in Spanish ED, and to determine the degree of variability among different professionals, as well as analyse factors that may influence their management. MATERIAL AND METHODS: A questionnaire was developed based on clinical cases, which was distributed among members of the Spanish Society of Paediatric Emergencies and attendees at the meeting in 2011. RESULTS: A total of 300 surveys were analysed. In 190 cases the place of work was in a tertiary care hospital. There was high agreement in the assessment of the severity of the cases mentioned. Over 90% use inhaled ß2 agonists in mild asthma exacerbations, 75.3% used oral corticosteroids in moderate exacerbations, and 79% use ipratropium bromide in severe exacerbations. Almost all (98%) considered Therapeutic Education important in the Emergency Department. Only 8 (2.7%) used peak expiratory flow measurements. Respondents working in a tertiary hospital used severity scales more frequently (90.5% vs 80%, P=.009) and administered parenteral corticosteroids less frequently (53.2% vs 66.4%, P=.017). CONCLUSIONS: Although a high percentage of paediatricians working in the ED follow Clinical Practice Guidelines, some different points of the approach among professionals have been identified.

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.

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)

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)

[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.

[Usefulness of oxygen saturation and peak expiratory flow in the management of acute asthma]. / Utilidad de la saturación de oxígeno y del pico máximo de flujo espiratorio en el manejo de las crisis asmáticas.

OBJECTIVE: The aim of the present study was to determine the usefulness of oxygen saturation (SaO2) and peak expiratory flow (PEF) in the assessment of severity of acute asthma and the discriminatory quality of their initial values in predicting the patient's hospitalization. PATIENTS AND METHODS: A prospective observational design was used. The study was carried out in the Emergency Department (ED) of an urban pediatric hospital with a 1993 census of 170,000 children. One hundred twenty-three children with previously diagnosed asthma, who presented to the ED with wheezing were included in the study. SaO2 and PEF levels were recorded upon arrival at the ED and after receiving initial treatment, prior to deciding the child's discharge or hospitalization. Children were treated according to the current practice guidelines. RESULTS: The mean SaO2 before and after the treatment was lower for the children who required admission to the hospital, 91.8 +/- 2% and 92.9 +/- 2%, respectively, than for those who were sent home, 96.1 +/- 3.2% and 96.5 +/- 1.8%, respectively (p < 0.01). The same happened with the PEF values, 41.3 +/- 17.8% and 54.8 +/- 17.9% for the admitted patients versus 68.3 +/- 17.9% and 90.1 +/- 10.6% for those sent home. An initial SaO2 of 95% had a sensitivity of 83% and a specificity of 79%. The optimal cut-off point for the PEF was 50%, with a sensitivity and a specificity of 81%. CONCLUSIONS: Our study shows that SaO2 and PEF can satisfactorily assess the seventy of acute asthma in children and that their initial values can predict the patient's outcome.

[Tracheobronchial aspiration of foreign bodies in children]. / Aspiración de cuerpo extraño en la infancia.

OBJECTIVE: Our objective was to study the characteristics and follow-up of children admitted to our Pediatric Emergency Room (PER) due to tracheobronchial inhalation of foreign bodies (FB). PATIENTS AND METHODS: We have reviewed retrospectively the 55 cases admitted over the last five years to our PER in whom the diagnosis of FB inhalation was confirmed. RESULTS: Mean age was 4 years with the peak incidence (25) occurring between 1 and 2 years of age. The second risk group was 11 years (8). In 84% of the patients (46), there was a history of FB aspiration. Twenty-five percent of the children (14) presented at the hospital within 24 hours, and 18% (10) more than 1 week after inhaling the FB. Physical examination was normal in 5%. The X-ray findings were: air trapping (74%), atelectasis (13%), in cases admitted more than 1 week after aspiration, and were normal in 13%. Rigid bronchoscopy and subsequent removal of the FB was the treatment instituted in 53 cases. There were no deaths. The FB was located at the right bronchus in 67%. The ingestion of nuts accounted for the highest incidence (72%), occurring mainly in younger children. Inorganic bodies constituted the majority of the cases in children older than 9 years (p = 0.0000). CONCLUSIONS: 1. Tracheobronquial inhalation of FB continues to not alarm the general population since only 25% presented at the hospital within 24 hours. 2. There are two risk groups, the second year of life (the largest) and the eleventh year, and they are different in the type of FB inhaled. 3. It is necessary to keep insisting on the methods of prevention.

[Mononucleosis syndromes with serology doubly positive to Epstein-Barr virus and cytomegalovirus]. / Síndromes mononucleósicos con serologías doblemente positivas a virus Epstein-Barr y citomegalovirus.

OBJECTIVE: The objective of this study is to present cases of infectious mononucleosis syndromes (i.m.) with dual rises in antibodies towards Epstein-Barr virus (EBV) and cytomegalovirus (CMV). PATIENTS AND METHODS: A prospective study of 49 children that fulfilled Sumaya's clinical criteria was carried out. RESULTS: Fifteen cases of i.m. were serologically positive for EBV, 12 for CMV, 2 for toxoplasma and 10 were serologically negative. The other ten had dual antibody rises to EBV and CMV. The symptoms were similar in the different groups. Significant differences were found only for the age at the time of presentation where below 4 years of age i.m. is rarely due to EBV (p < 0.01). Analytically, only elevated serum transaminase concentrations suggested the etiology of EBV (p < 0.05). Although i.m. with dual antibody rises towards EBV and CMV are more similar to cases due to EBV, they present characteristics from both viruses. CONCLUSIONS: 1. There are i.m. with dual antibody rises to EBV and CMV 2. The meaning still remains unknown, but there are two hypotheses: coinfection or "endogenous reinfection". 3. Cases of EBV-i.m. and CMV-i.m. are clinically similar, except at the age of presentation and the rising of serum transaminase concentrations.

[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.

[Urinary tract infection in infants: use of urine specimens obtained by suprapubic bladder aspiration in order to determine the reliability of culture specimen of urine collected in perineal bag]. / Infección urinaria en el lactante: comprobación por punción suprapúbica del rendimiento del cultivo de orina obtenido por bolsa perineal.

OBJECTIVE: To determine if culture specimens of urine collected in perineal bags is reliable in detecting urinary tract infections in infants. MATERIAL AND METHODS: A prospective study was carried out in a pediatric emergency room of an urban teaching hospital. Forty-eight infants, 12 months old or less, requiring an uncontaminated urine specimen due to the evaluation of febrile illness, suspected urinary tract infection or to a previously contaminated urine culture specimen. Two consecutive urine specimens were collected for culture. A urine specimen was collected in a perineal bag and afterwards all patients underwent suprapubic bladder aspiration. Cultures were considered positive if pure growth of more than 1.000 colonies/ml developed in the suprapubic aspiration urine specimen. RESULTS: Thirty-two infants had coincident cultures in both urine specimens. A positive culture specimen of urine collected in a perineal bag (pure growth of more than 100,000 colonies/ml) had high sensitivity (100%) and high specificity 88.6% in predicting positive cultures from urine obtained by suprapubic aspiration. CONCLUSION: A urine culture specimen meticulously collected with a perineal bag is a good screening method for detecting urinary tract infection in low risk infants.

[Wolff-Parkinson-White disease in childhood: follow up of 36 cases]. / Wolff-Parkinson-White en la infancia: seguimiento de 36 casos.

We have studied 36 patients (19 females and 17 males), controlled between 1973 and 1989, who suffered Wolff-Parkinson-White (WPW) pattern in their electrocardiogram. Epidemiological, clinical, diagnostic, therapeutic and evolutional data were reviewed. The mean age at the time of diagnosis was 4 years and 3 months, with 48% younger than six months of age. The average time for the follow-up period was 4 years and 2 months. There was not familiar occurrence. Six (16%) of the patients had associated heart disease. Seventeen (47%) had type A of WPW, 12 (33%) type B and 7 (20%) were not defined. An echocardiographic study was done in 20 patients (61%). Twenty-seven patients (75%) showed supraventricular tachycardia (SVT), which in 22 of these cases was the reason for seeking consultation. Children without SVT, 9 (25%), did not need any form of treatment. Twenty-four (889) of the patients with SVT required treatment to prevent recurrence. In the 27 studied episodes of SVT, Verapamil IV (55%) and vagal manoeuvres were the most efficient treatments. Seventeen (47%) of the patients presented a persistent WPW pattern and 11 (31%) experienced a normalization of their electrocardiogram with a mean time of 2 years-2 months.