Relación entre la utilización de recursos sanitarios y aspectos socioeconómicos en Atención Primaria / Relationship between the use of health resources and psychosocioeconomic aspects in Primary Care

Introducción: estudiar la influencia de los factores socioeconómicos y psicológicos familiares en la demanda y utilización de recursos sanitarios en las consultas pediátricas de Atención Primaria (AP). Material y métodos: estudio descriptivo observacional realizado mediante cuestionarios recogidos, durante un periodo de 1 año a familias de niños entre 1 mes y 14 años de edad pertenecientes a 2 consultas urbanas de AP de Madrid. Se analizaron datos crudos, comparaciones entre grupos y análisis multivariante. Resultados: se analizaron 434 cuestionarios. El número de consultas totales fue mayor en los pacientes de menor edad (p = 0,001) y en aquellos cuyos padres presentaban elevado nivel de ansiedad (p = 0,001). Las familias con todos sus miembros en paro presentaron niveles de ansiedad (odds ratio [OR]: 5,85; intervalo de confianza del 95% [IC 95]: 2,56 a 13,34; p <0,0001) y depresión (OR: 6,25; IC 95: 2,64 a 14,76; p <0,0001) significativamente superiores al resto. La realización de pruebas de laboratorio fue superior en los niños con enfermedad crónica (OR: 3,84; IC 95: 2,09 a 7,07; p <0,0001) y en aquellos con un nivel de ansiedad elevado en los padres (OR: 2,78; IC 95: 1,46 a 5,28); p = 0,02). La toma de fármacos fue superior en los niños con enfermedad crónica (OR: 3,15; IC 95: 1,60 a 6,19; p = 0,001) y menor en los niños de más edad (OR: 0,93; IC 95: 0,87 a 0,98; p = 0,014). Conclusiones: la frecuentación y el consumo de fármacos en general y antibióticos en particular, así como la solicitud de pruebas diagnósticas de laboratorio e imagen están directamente relacionados con el nivel elevado de ansiedad o depresión en los padres y con la presencia de enfermedad crónica en los niños e inversamente con la edad de los mismos. Sería recomendable la detección e intervención en los casos de elevada ansiedad parental para intentar reducir el consumo de recursos sanitarios (AU)

Introduction: the aim of our study was to analyse the influence of family socioeconomic and psychological factors on the demand and use of health resources in paediatric consultations in Primary Care.Methods: descriptive observational study carried out using questionnaires collected over a period of 1 year. Questionnaires were collected from children between 1 month and 14 years old, belonging to 2 urban Primary Care clinics in Madrid. The raw data was analysed, and comparisons between groups and multivariate analysis were performed.Results: we compared 434 questionnaires. The number of total consultations was higher in younger patients (p = 0.001) and in those whose parents presented high levels of anxiety (p = 0.001). Families with all their members in unemployed presented anxiety (OR: 5.85; IC 95: 2.567-13.341; p <0.0001) and depression (OR: 6.250; IC 95: 2.647-14.760; p <0.0001) levels higher than the rest. Laboratory and imaging test were higher in children with chronic disease (OR: 3.84; IC 95: 2.09-7.07; p <0.0001) and high level of anxiety in parents (OR: 2.78; IC 95: 1.46-5.28; p = 0.02). Drugs use was higher in children with chronic disease (OR: 3.15; IC 95: 1.60-6.19; p = 0.001) and lower in older children (OR: 0.927; IC 95: 0.87-0.98; p = 0.014).Conclusions: hyper-attendance and drug consumption in general and antibiotics in particular, as well as the request for imaging and laboratory test, is directly related to the high level of anxiety in the parents and the presence of chronic disease in children and inversely with the age. It would be advisable to detect and, if possible, intervene in cases of high parental anxiety in order to try to reduce the consumption of health resources. (AU)

Infección por adenovirus que requiere ingreso hospitalario: epidemiología, datos analíticos y manejo / Adenovirus infections that require hospital admission: epidemiology, laboratory findings and approach

Introducción: las infecciones por adenovirus tienen una presentación clínica variable y son una importante causa de morbilidad en la infancia. Frecuentemente reciben tratamiento antibiótico de forma innecesaria. Este estudio busca analizar las características de los pacientes con infección por adenovirus y ver si difieren de aquellos con infección bacteriana. Pacientes y métodos: se estudiaron 174 pacientes ingresados en un hospital terciario desde enero de 2009 hasta agosto de 2017 a los que se les detectó adenovirus. Se analizaron las variables clínicas y analíticas y se compararon con las de una muestra de pacientes diagnosticados de infección bacteriana confirmada en el mismo centro en 2016. Resultados: la tasa de pacientes con infección por adenovirus fue de 1,58/100 ingresos. El 64% eran varones, siendo la edad media de 17 meses. Los que solo presentaban síntomas gastrointestinales tenían una menor edad y resultados analíticos más favorables que los que solo mostraban síntomas respiratorios. Un 24,5% presentaban coinfección por otro virus, observándose en este grupo una mayor estancia hospitalaria (7,93 frente a 6,17 días, p = 0,006). Los criterios analíticos de infección bacteriana grave no mostraron diferencias significativas al comparar entre los pacientes infectados por adenovirus y los que tenían una infección bacteriana confirmada, excepto una diferencia mínima, aunque estadísticamente significativa, al comparar las cifras de proteína C reactiva. Conclusiones: las variables analíticas y clínicas estudiadas no son suficientes para discriminar entre infección bacteriana y por adenovirus. Sería adecuado descartar infección por adenovirus sistemáticamente antes de instaurar tratamiento antibiótico

Introduction: adenovirus infections have a heterogeneous clinical presentation and are an important cause of childhood morbidity. They are frequently and unnecessarily treated with antibiotics. In this study, we analysed the characteristic of patients with adenovirus infections in order to determine whether they differed from those of patients with bacterial infection. Patients and methods: the study included 174 patients admitted to a tertiary care hospital between January 2009 and August 2017 who tested positive for adenovirus. We analysed the clinical and laboratory findings in these patients and compared them to those of a group of patients that received a diagnosis of confirmed bacterial infection in the same hospital in 2016. Results: the incidence of adenovirus was of 1.58 cases per 100 admissions. Sixty-four percent of the sample was male, and the mean age was 17 months. Patients that presented with gastrointestinal symptoms alone were younger and had more favourable laboratory findings compared to patients with respiratory symptoms alone. Coinfection with another virus was found in 24.5%, and this group had a longer length of stay (7.93 versus 6.17 days, p = 0.006). We found no significant differences in the laboratory criteria indicative of severe bacterial infection between the patients with adenovirus infection and the controls with a confirmed bacterial infection except for a very small, although statistically significant, difference in the levels of C-reactive protein. Conclusions: the clinical and laboratory parameters analysed in our study are not sufficient to discriminate between bacterial infection and adenovirus infection. Thus, it would be appropriate to rule out adenovirus infection before initiating antibiotic treatment

Impacto de la contaminación ambiental en los ingresos hospitalarios pediátricos: estudio ecológico / Impact of environmental pollution on paediatric hospital admissions: an ecological study

Objetivo: estudiar la relación existente entre los niveles de contaminantes atmosféricos y los ingresos hospitalarios pediátricos totales y por patología respiratoria en particular. Pacientes y métodos: estudio ecológico en el cual la variable dependiente analizada han sido los ingresos pediátricos generales y aquellos por patología respiratoria, concretamente neumonías, crisis asmáticas y bronquiolitis, en un hospital del centro de Madrid durante seis años (2012-2017). Como variables independientes se estudiaron los valores promedio de contaminantes ambientales registrados en la ciudad de Madrid. Se calcularon coeficientes de correlación y regresión lineal múltiple. Se comparó el promedio de ingresos cuando los valores de dióxido de nitrógeno (NO2) eran superiores e inferiores a 40 µg/m3. Resultados: durante el periodo de tiempo estudiado se registraron 10 512 ingresos en Pediatría general, 5328 (50,68%) causados por procesos respiratorios. Se encontró una correlación entre los niveles de NO2, CO, benceno y los ingresos hospitalarios totales y respiratorios en todos los casos con un valor de p <0,0001. En la regresión lineal múltiple los ingresos totales se relacionaron con los niveles de NO2 positiva y negativamente con la temperatura, en relación con los ingresos respiratorios se incrementan con los niveles de NO2 y benceno y disminuyen con la temperatura. Se calculó que si los niveles de NO2 no hubieran superado en ningún mes los niveles de 40 µg/m3 se podrían haber evitado el 8,37% (IC 95: 7,77 a 8,98) de los ingresos totales y el 6,73% (IC 95: 6 a 7,52) de los ingresos respiratorios. Conclusiones: se encontró una relación entre los ingresos totales y por enfermedad respiratoria en la infancia y los niveles de contaminantes atmosféricos, especialmente NO2. La mejora de la calidad del aire podría evitar un porcentaje significativo de ingresos pediátricos y propiciarla debería ser tarea prioritaria para los pediatras

Objective: to assess the association between levels of airborne pollutants and paediatric hospital admissions, overall and due to respiratory problems. Patients and methods: we conducted an ecological study in which the dependent variables were the number of total paediatric hospital admissions and the number of paediatric admissions due to respiratory problems, specifically pneumonia, asthma exacerbations and bronchiolitis, in a hospital located in the centre of Madrid over a period of 6 years (2012-2017). The independent variables were the mean levels of air pollutants recorded in the city of Madrid. We calculated correlation coefficients and fit multiple linear regression models. We compared the average number of admissions when the levels of nitrogen (NO2) were above and below 40 µg/m3. Results: in the period under study, there were 10 512 admissions to the general paediatrics ward, of which 5328 (50.68%) were due to respiratory problems. We found a correlation between the levels of NO2, CO, and benzene and the number of overall admissions and respiratory admissions, in every instance with a p-value of less than 0.0001. The multiple linear regression analysis revealed that the number of overall admissions was associated with NO2 levels (positively) and temperature (negatively), while respiratory admissions were associated to NO2 and benzene levels (positively) and temperature (negatively). We estimated that if the levels of NO2 had stayed below 40 µg/m3 throughout the study period, 8.37% (95 CI: 7.77 to 8.98) of total admissions and 6.73% (95 CI: 6 to 7.52) of respiratory admissions could have been avoided. Conclusions: we found an association between the number of admissions, overall and for respiratory causes, in the paediatric age group and the levels of air pollutants, especially NO2. Improving air quality could prevent a significant proportion of paediatric hospital admissions, and promoting this change should be a priority for paediatricians

Aspectos psicosociales relacionados con la hiperfrecuentación en las consultas pediátricas de atención primaria / Psychosocial aspects associated with excessive attendance in primary care paediatric clinics

OBJETIVO: La hiperfrecuentación es un problema relevante en las consultas pediátricas de atención primaria, por lo que el objetivo de nuestro estudio ha sido analizar el nivel de frecuentación en dichas consultas y su relación con determinados aspectos psicosociales de las familias asignadas a las mismas. PACIENTES Y MÉTODOS: Estudio descriptivo observacional realizado mediante cuestionarios recogidos durante un periodo de 6 meses y registrando la frecuentación de los 6meses previos. Se han completado 346 encuestas de niños entre 6 meses y 13 años de edad pertenecientes a dos consultas urbanas de atención primaria de Madrid. Se analizaron datos crudos, comparaciones entre grupos y análisis multivariante. RESULTADOS: El promedio de consultas en los últimos 6meses, del total de incluidos en el estudio, fue de 3,06 en el centro de salud y de 0,77 consultas en urgencias. Se consideró hiperfrecuentadores a los que habían acudido 6 o más veces al centro de salud en este periodo (> p90), que fueron 33 niños (9,53%). En el análisis multivariante, las variables relacionadas con ser hiperfrecuentador en las consultas del centro de salud fueron la presencia de elevado nivel de ansiedad en los padres (OR = 5,50; IC 95%: 2,49-12,17; p < 0,0001) y la edad de los niños (OR = 0,73; IC95%: 0,58-0,91; p = 0,005). El modelo presentó un área bajo la curva de 0,761 (IC 95%: 0,678-0,945; p < 0,0001). CONCLUSIONES: La frecuentación en las consultas pediátricas de atención primaria está directamente relacionada con el nivel elevado de ansiedad de los padres e inversamente con la edad de los niños. Sería recomendable detectar y a ser posible intervenir en los casos de elevada ansiedad parental para así intentar reducir la hiperfrecuentación asistencial

OBJECTIVE: Hyper-attendance is a significant problem in paediatric Primary Care clinics. The aim of our study was to analyse the level of attendance in these clinics and its relationship with certain psychosocial aspects of the families attending them. PATIENTS AND METHODS: Observational descriptive study was conducted using questionnaires collected during a period of 6 months, as well as recording the frequency of attendance in the previous 6months. A total of 346 questionnaires of children between 6months and 13 years of age belonging to 2 urban Primary Care clinics in Madrid were completed. The raw data was analysed, and comparisons between groups and multivariate analysis were performed. RESULTS: The mean number of consultations in the last 6 months, of the total included in the study, was 3.06 in the Primary Care centre, and 0.77 in the emergency services. It was considered over-frequent for those who had attended the Primary Care health centre 6 or more times in this period (> p90), of which there were 33 children (9.53%). In the multivariate analysis, the variables related to being frequent users of Primary Care clinics were: the presence of high level of anxiety in the parents (OR = 5.50; 95% CI: 2.49-12.17, P < .0001), and the age of the children (OR = 0.73; 95% CI: 0.58-0.91, P = .005). The model presented an area under the curve of 0.761 (95% CI: 0.678-0.945, P < .0001). CONCLUSIONS: The frequency of visits in paediatric Primary Care clinics is directly related to the high level of anxiety of the parents, and inversely to the age of the children. It would be advisable to detect and, if possible, intervene in cases of high parental anxiety in order to try to reduce the over-frequency in the paediatric primary health care

[Psychosocial aspects associated with excessive attendance in primary care paediatric clinics]. / Aspectos psicosociales relacionados con la hiperfrecuentación en las consultas pediátricas de atención primaria.

OBJECTIVE: Hyper-attendance is a significant problem in paediatric Primary Care clinics. The aim of our study was to analyse the level of attendance in these clinics and its relationship with certain psychosocial aspects of the families attending them. PATIENTS AND METHODS: Observational descriptive study was conducted using questionnaires collected during a period of 6months, as well as recording the frequency of attendance in the previous 6months. A total of 346 questionnaires of children between 6months and 13years of age belonging to 2 urban Primary Care clinics in Madrid were completed. The raw data was analysed, and comparisons between groups and multivariate analysis were performed. RESULTS: The mean number of consultations in the last 6months, of the total included in the study, was 3.06 in the Primary Care centre, and 0.77 in the emergency services. It was considered over-frequent for those who had attended the Primary Care health centre 6 or more times in this period (>p90), of which there were 33 children (9.53%). In the multivariate analysis, the variables related to being frequent users of Primary Care clinics were: the presence of high level of anxiety in the parents (OR=5.50; 95%CI: 2.49-12.17, P<.0001), and the age of the children (OR=0.73; 95%CI: 0.58-0.91, P=.005). The model presented an area under the curve of 0.761 (95%CI: 0.678-0.945, P<.0001). CONCLUSIONS: The frequency of visits in paediatric Primary Care clinics is directly related to the high level of anxiety of the parents, and inversely to the age of the children. It would be advisable to detect and, if possible, intervene in cases of high parental anxiety in order to try to reduce the over-frequency in the paediatric primary health care.

Presentación clínica y tratamiento de los niños hospitalizados por gripe durante cinco temporadas / Clinical presentation and treatment of children hospitalised due to influenza from the 2012 to the 2016 season

Objetivo: estudiar las características clínicas y demográficas, así como el uso de oseltamivir, de los niños hospitalizados por gripe en un hospital pediátrico terciario. Pacientes y métodos: estudio descriptivo observacional de niños entre 0 y 18 años ingresados en las temporadas de diciembre a mayo de 2012 a 2017 con diagnóstico confirmado microbiológicamente de gripe. Resultados: se han estudiado 166 pacientes. El porcentaje de ingresos sobre el total de ingresados en las mismas fechas osciló entre el 2,03 y el 9,69%. El mayor número de ingresos fueron en la penúltima temporada de estudio (p <0,0001). Los niños diagnosticados de gripe A presentaron una edad menor que los que lo fueron de gripe B (2,45 frente a 3,88 años, p <0,0001), no encontrándose diferencias significativas en cuanto al sexo, los días de estancia media, la necesidad de antibioterapia o de broncodilatadores. Recibieron tratamiento con oseltamivir un total de 96 niños (57,83%), 75 de ellos en la temporada 2015-2016. No se encontraron diferencias en las características de los niños que lo recibieron frente a los que no. La estancia media global fue 0,89 días mayor en aquellos niños que recibieron el antiviral, diferencia casi significativa en el total de la muestra (p = 0,052), durante la temporada 2015-2016 la duración fue 1,8 días mayor (p = 0,039). No se encontraron diferencias significativas en cuanto al porcentaje de pacientes con neumonía ni de los que precisaron ingreso en la Unidad de Cuidados Intensivos Pediátricos entre los tratados respecto a los no tratados. Conclusiones: el porcentaje de niños ingresados por gripe es importante, habiéndose incrementado en la última temporada. Los niños diagnosticados con gripe A tienen una edad significativamente menor que los que presentaron gripe B. En nuestro caso no se encontraron ventajas en el tratamiento con oseltamivir

Objective: to analyse the demographic and clinical characteristics and the use of oseltamivir in children admitted with influenza to a tertiary care children's hospital. Patients and methods: we conducted a descriptive observational study of all patients aged 0 to 18 years admitted in every December-to-May epidemic season between 2012 and 2016 with a microbiological diagnosis of influenza. Results: we reviewed the cases of 166 patients. The percentage of influenza admissions out of the total admissions during the seasons under study between 2.03% and 9.69%. The highest number of admissions occurred in the second to last season under study (p < .0001). Children with infection by influenza A were younger compared to those with influenza B (2.45 vs. 3.88 years, p < .0001), and we found no significant differences between serotypes in the sex distribution, mean length of stay or need for antibiotherapy or bronchodilators. A total of 96 children (57.83%) received oseltamivir, 75 of them in the 2015-2016 season. We found no differences in the characteristics of children treated with oseltamivir compared to those that were not. The mean length of stay was 0.89 days overall and was greater in children treated with the antiviral drug, with p-values that neared the threshold for significance in the entire sample (p = .052); the length of stay was 1.8 days longer in the 2015-2016 season (p = .039). We did not find significant differences between patients that received oseltamivir and patients that did not in the percentage that developed pneumonia or the percentage that required admission to the paediatric intensive care unit. Conclusions: the percentage of children admitted with influenza virus was substantial and increased in the last season. Children with an influenza A diagnosis were younger compared to children with influenza B. Our study did not find advantages in the use of oseltamivir

Impacto de la contaminación ambiental en las consultas pediátricas de Atención Primaria: estudio ecológico / Impact of air pollution in paediatric consultations in Primary Health Care: Ecological study

OBJETIVO: Estudiar la relación existente entre los niveles de contaminantes ambientales y la demanda por enfermedad respiratoria en las consultas pediátricas de Atención Primaria. PACIENTES Y MÉTODOS: Estudio ecológico en el que la variable dependiente analizada ha sido la demanda en las consultas pediátricas de un centro de salud urbano de Madrid durante 3 años (2013-2015) por bronquiolitis, episodios de broncoespasmo y procesos respiratorios de vías altas. Como variables independientes se estudiaron los valores de contaminación ambiental. Se calcularon coeficientes de correlación y regresión lineal múltiple. Se comparó el promedio de consultas cuando los valores de dióxido de nitrógeno (NO2) eran superiores e inferiores a 40 mig/m3. RESULTADOS: Durante el periodo de tiempo estudiado hubo un total de 52.322 consultas pediátricas en el centro de salud, de las cuales 6.473 (12,37%) lo fueron por procesos respiratorios. Se encontró correlación positiva entre los niveles de SO2, CO, NO2, NOx, benceno y el número de consultas por procesos respiratorios y negativa con la temperatura y el O3. El número de consultas por enfermedad respiratoria fue significativamente mayor cuando los niveles de NO2 superaban los 40 mig/m3. En la regresión lineal múltiple (p < 0,0001) solo se mantuvo la relación positiva de las consultas con los niveles de NO2 (3,630; IC 95%: 0,691-6,570) y negativa con la temperatura (-5,957; IC 95%: -8,665 a -3,248). CONCLUSIONES: La contaminación ambiental por NO2 está relacionada con el aumento de la enfermedad respiratoria en la infancia. Los pediatras deberíamos contribuir a propiciar la mejora de la calidad del aire como una importante medida preventiva

OBJECTIVE: To study the correlation between the levels of environmental pollutants and the number of paediatric consultations related to respiratory disease in Primary Health Care. PATIENTS AND METHODS: An ecological study is performed, in which the dependent variable analysed was the number of paediatric consultations in an urban Primary Health Care centre in Madrid over a 3 year period (2013-2015), and specifically the consultations related to bronchiolitis, recurrent bronchospasm, and upper respiratory diseases. The independent variables analysed were the levels of environmental pollutants. Coefficients of correlation and multiple lineal regressions were calculated. An analysis has been carried out comparing the average of paediatric consultations when the levels of nitrogen dioxide (NO2) were higher and lower than 40 mig/m3. RESULTS: During the period of the study, there were a total of 52,322 paediatric consultations in the health centre, of which 6,473 (12.37%) were related to respiratory diseases. A positive correlation was found between SO2, CO, NOx and NO2 and benzene levels and paediatric consultations related to respiratory diseases, and a negative correlation with temperature. The number of consultations was significantly higher when NO2 levels exceeded 40 mig/m3. In the multiple lineal regression (P=.0001), the correlation was only positive between consultations and NO2 levels (3.630, 95% CI: 0.691-6.570), and negative with temperature (-5,957, 95% CI: -8.665 to -3.248). CONCLUSIONS: NO2 environmental pollution is related to an increase in respiratory diseases in children. Paediatricians should contribute to promote an improvement in urban air quality as a significant preventive measure

Modelo sanitario, índice de calidad asistencial y gasto sanitario público / Health model, care quality and health spending public

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Recortes en los presupuestos sanitarios y listas de espera / Cutbacks in health budgets and waiting lists

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[Impact of air pollution in paediatric consultations in Primary Health Care: Ecological study]. / Impacto de la contaminación ambiental en las consultas pediátricas de Atención Primaria: estudio ecológico.

OBJECTIVE: To study the correlation between the levels of environmental pollutants and the number of paediatric consultations related to respiratory disease in Primary Health Care. PATIENTS AND METHODS: An ecological study is performed, in which the dependent variable analysed was the number of paediatric consultations in an urban Primary Health Care centre in Madrid over a 3 year period (2013-2015), and specifically the consultations related to bronchiolitis, recurrent bronchospasm, and upper respiratory diseases. The independent variables analysed were the levels of environmental pollutants. Coefficients of correlation and multiple lineal regressions were calculated. An analysis has been carried out comparing the average of paediatric consultations when the levels of nitrogen dioxide (NO2) were higher and lower than 40µg/m3. RESULTS: During the period of the study, there were a total of 52,322 paediatric consultations in the health centre, of which 6,473 (12.37%) were related to respiratory diseases. A positive correlation was found between SO2, CO, NOx and NO2 and benzene levels and paediatric consultations related to respiratory diseases, and a negative correlation with temperature. The number of consultations was significantly higher when NO2 levels exceeded 40µg/m3. In the multiple lineal regression (P=.0001), the correlation was only positive between consultations and NO2 levels (3.630, 95% CI: 0.691-6.570), and negative with temperature (-5,957, 95% CI: -8.665 to -3.248). CONCLUSIONS: NO2 environmental pollution is related to an increase in respiratory diseases in children. Paediatricians should contribute to promote an improvement in urban air quality as a significant preventive measure.

Creación de un modelo probabilístico de diagnóstico de infección bacteriana grave en lactantes febriles de 0 a 3 meses de vida / Construction of a diagnostic prediction model of severe bacterial infection in febrile infants under 3 months old

Introducción: La fiebre es motivo frecuente de consulta pediátrica y en menores de 3 meses su diagnóstico etiológico es difícil, siendo un grupo de pacientes con mayor tasa de infección bacteriana grave (IBG). Nuestro objetivo es encontrar un modelo predictivo de IBG en menores de 3 meses con fiebre sin foco. Métodos: Se estudió a los niños menores de 3 meses con fiebre sin foco ingresados, realizándose pruebas complementarias según protocolo clínico. Se analizaron además los criterios de Rochester de bajo grado de IBG. Se diseñó un modelo predictivo de IBG y cultivo positivo, incluyendo las siguientes variables en el modelo máximo: proteína C reactiva (PCR), procalcitonina (PCT) y cumplimiento o no de menos de 4 criterios de Rochester. Resultados: Se incluyó a 702 sujetos; el 22,64% presentaba IBG y el 20,65% cultivos positivos. Los que presentaban IBG y cultivo positivo presentaron más leucocitos, neutrófilos totales, PCR y PCT. Se obtuvieron significación estadística en puntuación de Rochester menor de 4 y valores de PCR y PCT para IBG (área bajo la curva [ABC] 0,877) y para cultivos positivos (ABC 0,888). Con la regresión se obtuvieron unas fórmulas de predicción de IBG y cultivo positivo con sensibilidad del 87,7 y el 91%, especificidad del 70,1 y el 87,7%, CPP de 2,93 y 3,62 y CPN de 0,17 y 0,10, respectivamente. Conclusiones: Los modelos predictivos son válidos y mejoran discretamente la validez de los criterios de Rochester para cultivo positivo en menores de 3 meses ingresados con fiebre (AU)

Introduction: Fever is a common cause of paediatric admissions in emergency departments. An aetiological diagnosis is difficult to obtain in those less than 3 months of age, as they tend to have a higher rate of serious bacterial infection (SBI). The aim of this study is to find a predictor index of SBI in children under 3 months old with fever of unknown origin. Methods: A study was conducted on all children under 3 months of age with fever admitted to hospital, with additional tests being performed according to the clinical protocol. Rochester criteria for identifying febrile infants at low risk for SBI were also analysed. A predictive model for SBI and positive cultures was designed, including the following variables in the maximum model: C-reactive protein (CRP), procalcitonin (PCT), and meeting not less than four of the Rochester criteria. Results: A total of 702 subjects were included, of which 22.64% had an SBI and 20.65% had positive cultures. Children who had SBI and a positive culture showed higher values of white cells, total neutrophils, CRP and PCT. A statistical significance was observed with less than 4 Rochester criteria, CRP and PCT levels, an SBI (area under the curve [AUC] 0.877), or for positive cultures (AUC 0.888). Using regression analysis a predictive index was calculated for SBI or a positive culture, with a sensitivity of 87.7 and 91%, a specificity of 70.1 and 87.7%, an LR+ of 2.93 and 3.62, and a LR- of 0.17 and 0.10, respectively. Conclusions: The predictive models are valid and slightly improve the validity of the Rochester criteria for positive culture in children less than 3 months admitted with fever (AU)

[Construction of a diagnostic prediction model of severe bacterial infection in febrile infants under 3 months old]. / Creación de un modelo probabilístico de diagnóstico de infección bacteriana grave en lactantes febriles de 0 a 3 meses de vida.

INTRODUCTION: Fever is a common cause of paediatric admissions in emergency departments. An aetiological diagnosis is difficult to obtain in those less than 3 months of age, as they tend to have a higher rate of serious bacterial infection (SBI). The aim of this study is to find a predictor index of SBI in children under 3 months old with fever of unknown origin. METHODS: A study was conducted on all children under 3 months of age with fever admitted to hospital, with additional tests being performed according to the clinical protocol. Rochester criteria for identifying febrile infants at low risk for SBI were also analysed. A predictive model for SBI and positive cultures was designed, including the following variables in the maximum model: C-reactive protein (CRP), procalcitonin (PCT), and meeting not less than four of the Rochester criteria. RESULTS: A total of 702 subjects were included, of which 22.64% had an SBI and 20.65% had positive cultures. Children who had SBI and a positive culture showed higher values of white cells, total neutrophils, CRP and PCT. A statistical significance was observed with less than 4 Rochester criteria, CRP and PCT levels, an SBI (area under the curve [AUC] 0.877), or for positive cultures (AUC 0.888). Using regression analysis a predictive index was calculated for SBI or a positive culture, with a sensitivity of 87.7 and 91%, a specificity of 70.1 and 87.7%, an LR+ of 2.93 and 3.62, and a LR- of 0.17 and 0.10, respectively. CONCLUSIONS: The predictive models are valid and slightly improve the validity of the Rochester criteria for positive culture in children less than 3 months admitted with fever.

El efecto de los copagos sobre la adherencia a los medicamentos prescritos / Effect of co-payments on the adherence to prescribed medications

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Sueroterapia y riesgo de hiponatremia iatrogénica en niños hospitalizados con gastroenteritis aguda: estudio prospectivo / Fluid therapy and iatrogenic hyponatraemia risk in children hospitalised with acute gastroenteritis: prospective study

Objetivo: Determinar si la utilización de sueros hipotónicos supone un riesgo en la aparición de hiponatremia iatrogénica en los niños hospitalizados por gastroenteritis aguda (GEA). Pacientes y método: Estudio prospectivo realizado con 205 pacientes de edades comprendidas entre 1 y 28 meses e ingresados con diagnóstico de deshidratación leve o moderada por GEA para recibir sueroterapia en la sección de lactantes de un hospital pediátrico de Madrid (España). El grado de deshidratación inicial se estimó con mediciones clínicas estándar. El suero administrado fue glucosalino 0,3 % en 198 casos y en los 7 casos restantes, todos con hipernatremia inicial, se administró suero glucohiposalino 0,2 %. Se analizó la respuesta a los líquidos intravenosos según si el niño se hallaba normo, hipo o hipernatrémico antes de iniciar el tratamiento. Las cifras de sodio en sangre y la excreción fraccional de sodio (EFNa) se consideraron como medidas de resultado. Resultados: Los 205 pacientes incluidos en el estudio se distribuyeron en tres grupos según el resultado inicial de la natremia. En 37 casos se detectó hiponatremia (18,04 %), en 133 niños isonatremia (64,87 %) y en 35 niños hipernatremia (17,07 %). Después de administrar soluciones hipotónicas encontramos en todos los grupos diferencia significativa entre el sodio sérico inicial y el final; en el grupo con hiponatremia el sodio subió y en los grupos con iso e hipernatremia el sodio descendió ligeramente. Se evidenció correlación significativa entre la EFNa y la evolución de la natremia (Na sérico inicial - Na sérico final). No se detectó ningún caso de hiponatremia posinfusión y tampoco se encontró correlación entre el agua libre administrada y la evolución de la natremia. Conclusiones: En lactantes con funcionamiento renal normal no se ha encontrado hiponatremia como resultado de la administración de sueros hiposalinos intravenosos, hallándose diferencias significativas en la EFNa que indican el ajuste renal de la natremia (AU)

Objective: The purpose of this study is to analyse whether the use of hypotonic fluids increases the risk of iatrogenic hyponatraemia in children hospitalised with acute gastroenteritis (AGE). Patients and methods: Prospective study carried out on 205 patients with ages ranging from 1 to 28 months and admitted with a diagnosis of mild or moderate dehydration due to AGE and treated with intravenous hypotonic fluids in a paediatric department in Madrid (Spain). The degree of dehydration at presentation was estimated using standard clinical measures. 198 children received 0.3 % glucosaline solution and in 7 patients, with baseline hypernatraemia, 0.2 % gluco-hyposaline solution was administered. We analysed the results according to whether children were hyponatraemic, normonatraemic or hypernatraemic at presentation. The blood and urine samples were analysed and the concentration of sodium and fractional sodium excretion (EFNa) before and after intervention were considered as outcome measures. Results: The 205 patients included in the study were distributed in 3 groups according to the baseline natraemia results. In 37 cases we detected hyponatraemia (18.04%), in 133 cases isonatraemia (64.87%) and in 35 children hypernatraemia (17.07%). After administering hypotonic fluids we detected a significant difference between initial and final natraemia in all groups; in the group with hyponatraemia, sodium increased and in the groups with iso and hypernatraemia, sodium slightly decreased. A significant correlation between the EFNa and the evolution of natraemia was found. No cases of hyponatraemia post-infusion were seen and there was no correlation between free water administered and natraemia evolution. Conclusions: Results show that the use of hypotonic fluids does not increase the risk of hospital acquired hyponatraemia in hospitalised children with normal renal function. Our children with gastroenteritis did not develop hyponatraemia even though they were all treated with hypotonic intravenous solutions (AU)

Fluid therapy and iatrogenic hyponatraemia risk in children hospitalised with acute gastroenteritis: prospective study.

OBJECTIVE: The purpose of this study is to analyse whether the use of hypotonic fluids increases the risk of iatrogenic hyponatraemia in children hospitalised with acute gastroenteritis (AGE). PATIENTS AND METHODS: Prospective study carried out on 205 patients with ages ranging from 1 to 28 months and admitted with a diagnosis of mild or moderate dehydration due to AGE and treated with intravenous hypotonic fluids in a paediatric department in Madrid (Spain). The degree of dehydration at presentation was estimated using standard clinical measures. 198 children received 0.3 % glucosaline solution and in 7 patients, with baseline hypernatraemia, 0.2 % gluco-hyposaline solution was administered. We analysed the results according to whether children were hyponatraemic, normonatraemic or hypernatraemic at presentation. The blood and urine samples were analysed and the concentration of sodium and fractional sodium excretion (EFNa) before and after intervention were considered as outcome measures. RESULTS: The 205 patients included in the study were distributed in 3 groups according to the baseline natraemia results. In 37 cases we detected hyponatraemia (18.04%), in 133 cases isonatraemia (64.87%) and in 35 children hypernatraemia (17.07%). After administering hypotonic fluids we detected a significant difference between initial and final natraemia in all groups; in the group with hyponatraemia, sodium increased and in the groups with iso and hypernatraemia, sodium slightly decreased. A significant correlation between the EFNa and the evolution of natraemia was found. No cases of hyponatraemia post-infusion were seen and there was no correlation between free water administered and natraemia evolution. CONCLUSIONS: RESULTS show that the use of hypotonic fluids does not increase the risk of hospital acquired hyponatraemia in hospitalised children with normal renal function. Our children with gastroenteritis did not develop hyponatraemia even though they were all treated with hypotonic intravenous solutions.