Incidencia y pronóstico de las lesiones cardíacas en el politraumatizado pediátrico / Incidence and prognosis of cardiac lesions in the paediatric polytraumatised patient

Objetivos: Conocer la incidencia y pronóstico de las lesiones cardíacas en el politraumatizado pediátrico. Conocer la trascendencia de un correcto diagnóstico, especialmente cuando el paciente no va a ser susceptible de cuidados intensivos. Métodos: Revisión bibliográfica. Selección de los artículos que respondían a una o varias de las siguientes cuestiones: 1. ¿Cuál es la incidencia de lesión cardíaca en el politrauma pediátrico? 2. ¿Diagnosticamos las lesiones cardíacas? 3. ¿Hacemos seguimiento de las lesiones cardíacas diagnosticadas? 4. Pronóstico. Resultados y conclusiones: 1. No hay datos suficientes sobre la frecuencia de lesión cardíaca diagnosticada en el seno del traumatismo torácico infantil. 2. Es posible que la lesión cardíaca esté infradiagnosticada, cobrando relevancia el diagnóstico de sospecha. 3. La decisión de monitorizar a un paciente depende de la situación clínica y del resultado de las pruebas complementarias. 4. El pronóstico de la lesión cardíaca en el niño politraumatizado es favorable si estamos ante una contusión cardíaca, sin olvidar que la condición de politraumatizado puede resultar definitiva en cuanto a mortalidad se refiere (AU)

Aims and objectives: To assess and establish the incidence and prognosis of cardiac lesions in the paediatric polytraumatised patient. To assess the significance of a correct diagnosis, particularly when the patient will not be amenable to intensive care. Methods: Bibliographic review, with selection of those papers responding to one or more of the following questions: (1) Which is the incidence of cardiac lesion in paediatric polytraumatised patients? (2) Do we diagnosed cardiac lesions? (3) Do we follow up the already diagnosed cardiac lesions? (4) What is the prognosis? Results and Conclusions: [to (1)]: There are no sufficient data regarding the diagnosis and frequency of cardiac lesion diagnosed in the context of paediatric thoracic traumatism. [to (2)]: It is quite possible that cardiac lesions are underdiagnosed, whereby the "suspicion" diagnosis becomes relevant. [to (3)] The decision to monitor a given patient depends on the clinical situation and on the results of complementary tests and analyses. [to 4]: Prognosis in the polytraumatised child is quite favourable in the presence of cardiac contusion; however, the "polytraumatised" condition may become definitory as regards mortality (AU)

[Gonarthrosis in primary care: can analytical and radiological tests de done away with?]. / Gonartrosis en atención primaria: se puede prescindir de las pruebas analíticas y radiológicas?

OBJECTIVES: To evaluate if the rheumatologic clinical criteria established for the diagnosis of knee osteoarthritis are valid in primary care and if it is possible to do without the laboratory and radiologic criteria. DESIGN: Descriptive study of the agreement between the diagnosis exclusively clinical and the clinical, laboratory and radiologic diagnosis according the American Rheumatism Association (ARA) criteria. SETTING: Population of the health area of Talavera de la Reina (Toledo). PATIENTS: People with one or both knees non referred pain during the previous month, in spite of their characteristics, length or periodicity. MEASUREMENTS AND RESULTS: The ARA and R.D. Altman clinical diagnosis criteria of knee osteoarthritis were applied to the sample and they were compared with the diagnosis obtained with the clinical, laboratory and radiological criteria (reference diagnosis). The clinical diagnosis of knee osteoarthritis was established according the ARA criteria in 93% cases, according Altman in 86% and according the reference diagnosis in 87%. The sensibility and positive predictive value obtained using both clinical criteria are high, but the specificity is very low. CONCLUSIONS: The clinical criteria can be used in primary care, although they have a low specificity. It could be necessary to establish new criteria to ameliorate the specificity and the handling of these patients in primary care, to avoid unnecessary explorations.