Servicio de Urgencias de Pediatría del Hospital Universitario Cruces / Pediatrics Emergency Department of the Hospital Universitario Cruces

El Servicio de Urgencias de Pediatría (SUP) del Hospital Universitario de Cruces ha experimentado durante los últimos 15 años cambios profundos en su estructura, organización y profesionalización de su equipo médico y de enfermería. La implantación de un sistema de gestión de la calidad, en el año 2004, en el SUP ha impulsado mejoras en su actividad asistencial, docente y de investigación. Nuestro Servicio ofrece una atención integral al niño, lo que comprende aspectos tan trascendentes y polivalentes como la atención inicial al niño politraumatizado,reanimación cardiopulmonar, el uso de técnicas de analgesia y sedación, reparación de heridas, urgencias oftalmológicas y ORL, urgencias traumatológicas, además de todas las urgencias de tipo médico. La docencia e investigación son parte fundamental de las actividades del Servicio y son responsables en gran manera de su desarrollo actual. La participación en reuniones científicas y el desarrollo de redes de investigación de ámbito nacional e internacional, han sido y son motores de la mejora de la calidad del Servicio (AU)

The Pediatric Emergency Department (PED) of the Cruces University Hospital has experienced over the last 15 years profound changes in its structure, organization and professionalism of the medical team and nursing. The implementation of a system of quality management, in 2004, in the PED has driven improvements in their daily work, teaching and research. Our service offers comprehensive care for children, which indudes such important and versatile aspects such as multiple trauma care, resuscitation, use of analgesia and sedation techniques, wound repair, ophthalmology and ENT emergencies, orthopedic emergencies, as well of all medical conditions. Teaching and research are an essential part of the activities of the PED and are responsible largely on its current deve!opment. Participation in scientific meetings and developing research networks nationally and internationally, have been and are engines improving the quality of service (AU)

[Accidental ingestion of superwarfarins]. / Ingesta accidental de superwarfarinas.

Superwarfarins were developed around 1970 in order to resolve the resistance developed by the rodents to the previously existing rodenticides. Superwarfarins cause, nowadays, most of the poisonings due to rodenticides. However, in our environment, it has been extremely uncommon to attend children with such poisonings. We present five children aged less than 4 years with unintentional ingestion of a superwarfarin, admitted in a Pediatric Emergency Department in 1 year time, and a revision of the literature.

Ingesta accidental de superwarfarinas / Accidental ingestion of superwarfarins

Las denominadas superwarfarinas se desarrollaron a partir de la década de 1970 como solución a las resistencias que habían desarrollado los roedores a los raticidas hasta entonces existentes. Las superwarfarinas motivan hoy en día la mayoría de las intoxicaciones por raticidas, aunque, en nuestro país, han sido excepcionales en edad pediátrica. Se presentan cinco casos correspondientes a ingestas accidentales de superwarfarinas en menores de 4 años atendidos en 1 año en un servicio de urgencias pediátrico y una revisión de la literatura médica (AU)

Superwarfarins were developed around 1970 in order to resolve the resistance developed by the rodents to the previously existing rodenticides. Superwarfarins cause, nowadays, most of the poisonings due to rodenticides. However, in our environment, it has been extremely uncommon to attend children with such poisonings. We present five children aged less than 4 years with unintentional ingestion of a superwarfarin, admitted in a Pediatric Emergency Department in 1 year time, and a revision of the literatura (AU)

Bronquiolitis aguda: ¿por qué no se aplica lo que se publica? Barreras en la transmisión del conocimiento / No disponible

No disponible

Fiebre en el lactante: herramientas actuales para dudas diagnósticas clásicas / Fever in the infant: current tools to answer classical diagnostic questions

No disponible

Intoxicaciones pediátricas en Atención Primaria / Paediatric poisoning in Primary Care

Las intoxicaciones son un motivo de consulta poco habitual en la edad pediátrica y, en muchas ocasiones, no se trata de intoxicaciones verdaderas sino de contactos con una sustancia en una dosis que no genera problemas. La edad diferencia grupos de intoxicaciones con pronóstico diferente. Los menores de 7-8 años consultan por intoxicaciones accidentales, generalmente fármacos y, menos frecuentemente, productos del hogar. Los mayores de 10-11 años lo hacen por intoxicaciones con fin recreativo y, en menos ocasiones, con intención suicida. En este grupo, el abordaje es más complejo y los tóxicos más habitualmente implicados son el alcohol y las drogas ilegales. La existencia de una situación de riesgo para un niño viene determinada por la presencia de síntomas derivados de la intoxicación o la existencia de potencial toxicidad. Las intoxicaciones accidentales más habituales se deben a la ingesta de presentaciones líquidas de paracetamol. En el caso de desconocer el tóxico ingerido existen tablas que permiten identificarlo a partir de hallazgos exploratorios. El método de descontaminación gastrointestinal de elección es el carbón activado. Todos los centros a los que un niño o adolescente pueda acudir en busca de atención médica debieran disponer de carbón activado. En los casos en los cuales es necesario administrarlo, es prioritario hacerlo lo antes posible. Las pruebas complementarias desempeñan una muy escasa función fuera del ámbito hospitalario. Es excepcional que un antídoto resuelva una situación crítica. En estos casos, lo obligado es realizar un correcto ABC (AU)

Childhood poisoning represents an infrequent cause of admission in paediatric emergency departements and Primary Health Care. In most cases, the ingested agent has minimal or no clinically important toxic effects. Occasionally, however, such ingestion can be life threatening or can even result in death. There is an age cut-off in paediatric poisonings, with different prognosis. In this way, patients less than 7-8 years are admitted by non-intentional poisonings, generally drugs and, less frequently, domestic products. Deliberate self-poisoning and unintentional intoxication during recreational activities are frequent circumstances of poisoning in older children and teenagers, being therapeutic approach more complex. The child admitted with symptoms derived from the poisoning presence is in a risk situation. Most common non-intentional poisonings are due to the ingestion of liquid presentations of acetaminophen. If the ingested substance is not known, toxidrome tables are a very useful tool in the management of these patients. Activated charcoal is the first choice procedure if gastrointestinal decontamination is indicated. Every medical centre should have activated charcoal in order to treat correctly and quickly the most common paediatric poisonings. Additional tests are not very useful in the out-hospital setting and it’s very uncommon an antidote to save the life of a child. In life-threatening situations it's mandatory to perform a correct ABC (AU)

Cambios de los hábitos poblacionales en el tratamiento de la fiebre en la infancia / Change in habits among the population in the management of childhood fever

No disponible

[Acute onset ataxia in infancy: its aetiology, treatment and follow-up]. / Ataxia de aparición aguda en la infancia: etiología, tratamiento y seguimiento.

INTRODUCTION: Acute childhood ataxia is a cause of referency to the pediatric emergency room. AIM. To characterize the etiology, clinical picture, management, and outcome of acute ataxia in our hospital. PATIENTS AND METHODS: A prospective study was undertaken including 39 children with acute ataxia who were admitted between January 1, 2001 and December 31, 2003. RESULTS: During the study period 159,002 episodes were evaluated, 39 children (0.024%) with acute ataxia. The most common diagnoses were post-infectious ataxia (51.2%) and toxic exposure (25.6%). The mean age at presentation in post-infectious ataxia was 55 +/- 27.61 months, 60% females. A prodromal febrile illness was noted in 95%: varicella (10), nonspecific viral infection (6), mycoplasma, enterovirus, and Epstein-Barr virus. The latency from the prodromal illness to the onset of ataxia was 5.86 +/- 3.78 days. Lumbar punctures were altered in 11/17. All computed tomography scans performed were normal. At follow up, one boy presented asymmetric signs of cerebellar dysfunction secondary to hemicerebellitis. The media of the patient who showed full-gait recovery was 18 days, and was complete in all children, except one boy who presented hemophagocytic lymphohistiocytosis. Toxic ingestion was the second most common cause. Boys less than 6 years were more commonly affected. CONCLUSIONS: Acute childhood ataxia are an uncommon cause of presentation to our pediatric emergency room. Postinfectious ataxia and drug ingestion are the most common diagnosis, with a usually benign and self-limited process. A thorough history and neurology examination should be guided to etiology. Neuroimaging studies and hospitalization are needed only if atypical presentation, asymmetric neurologic examination and prolonged ataxia.

[Bronchodilators via metered-dose inhaler with spacer in the pediatric emergency department: what is the dosage?]. / Broncodilatadores inhalados mediante MDI con cámara espaciadora en urgencias pediátricas: cuál es la dosis?

INTRODUCTION: Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage. OBJECTIVE: To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department. METHODS: This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child's weight (1 puff of salbutamol = 100 microg and 1 puff of terbutaline = 250 microg) and the other group received a number of puffs equivalent to one-third of the child's weight. RESULTS: Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (6 SD) age (58.34 +/- 34.72 vs 66.04 +/- 36.45 months), arterial oxygen saturation (95.49 +/- 1.93 vs 95.56 +/- 1.97) or pulmonary score (4.04 +/- 1.55 vs 3.97 +/- 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 +/- 1.60 vs 96.18 +/- 1.77], pulmonary score [1.87 +/- 1.33 vs 1.64 +/- 1.31]). The number of doses administered (2.17 +/- 0.91 vs 2.24 +/- 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups. CONCLUSIONS: The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children.

Ataxia de aparición aguda en la infancia: etiología, tratamiento y seguimiento / Accute onset ataxia in indancy: its aetiology, treatment and follow-up

Introducción. La ataxia de aparición aguda en la infancia es una causa de referencia al Servicio de Urgencias de Pediatría. Objetivo. Describir la etiología, la actitud diagnóstico-terapéutica y el seguimiento de los niños que consultaron por ataxia aguda en urgencias. Pacientes y métodos. Estudio prospectivo de 39niños diagnosticados de ataxia aguda entre el 1 de enero de 2001y el 31 de diciembre de 2003. Resultados. Durante este período se valoraron 159.002 episodios, 39 niños (0,024%) presentaron una ataxia aguda. Las causas más frecuentes fueron: postinfecciosa (51,28%) e intoxicación (25,64%), seguidas de un grupo heterogéneo de patologías. En la ataxia postinfecciosa, la edad media fue55 ± 27,61 meses, el 60% niñas. El 95% tenía un cuadro infeccioso previo: varicela (10), viral inespecífica (6), micoplasma, enterovirus, y virus de Epstein-Barr. El tiempo de evolución hasta la aparición de ataxia fue 5,86 ± 3,78 días. El líquido cefalorraquídeo fue patológico en 11 de 17. La neuroimagen fue normal. Durante el seguimiento, un niño presentó focalidad hemicerebelosa secundaria a una hemicerebelitis. Todos se recuperaron (media: 18 días), excepto un niño que debutó con una linfohistiocitosis hemofagocítica. La intoxicación fue la segunda causa más frecuente, con predominio en niños (o varones) menores de 6 años. Conclusiones. Las ataxias agudas son un motivo de consulta infrecuente en urgencias. Las ataxias postinfecciosas y tras intoxicación son las más usuales y siguen por lo general un curso benigno y autolimitado. La historia clínica y exploración neurológica nos orientarán hacia la etiología. La neuroimagen y el ingreso hospitalario deberían reservarse para presentaciones atípicas, signos de focalidad neurológica y duración prolongada del cuadro (AU)

Introduction. Acute childhood ataxia is a cause of referency to the pediatric emergency room. Aim. To characterize the etiology, clinical picture, management, and outcome of acute ataxia in our hospital. Patients and methods. A prospective study was undertaken including 39 children with acute ataxia who were admitted between January 1, 2001 and December 31,2003. Results. During the study period 159,002 episodes were evaluated, 39 children (0.024%) with acute ataxia. The most common diagnoses were post-infectious ataxia (51.2%) and toxic exposure (25.6%). The mean age at presentation in postinfectiusataxia was 55 ± 27.61 months, 60% females. A prodromal febrile illness was noted in 95%: varicella (10), nonspecific viral infection (6), mycoplasma, enterovirus, and Epstein-Barr virus. The latency from the prodromal illness to the onset of ataxia was 5.86 ± 3.78 days. Lumbar punctures were altered in 11/17. All computed tomography scans performed were normal. At follow up, one boy presented asymmetric signs of cerebellar dysfunction secondary to hemicerebellitis. The media of the patient who showed full-gait recovery was 18 days, and was complete in all children, except one boy who presented hemophagocyticlymphohistiocytosis. Toxic ingestion was the second most common cause. Boys less than 6 years were more commonly affected. Conclusions. Acute childhood ataxia are an uncommon cause of presentation to our pediatric emergency room. Post infectious ataxia and drug ingestion are the most common diagnosis, with a usually benign and self-limited process. A thorough history and neurology examination should be guided to etiology. Neuroimaging studies and hospitalization are needed only if atypical presentation, asymmetric neurologic examination and prolonged ataxia (AU)

Broncodilatadores inhalados mediante MDI con cámara espaciadora en urgencias pediátricas: ¿cuál es la dosis? / Bronchodilators via Metered-Dose Inhaler with Spacer in the Pediatric Emergency Department: What is the dosage?

Introducción. Los broncodilatadores administrados mediante aerosol dosificador presurizado (MDI) con cámara espaciadora son tan eficaces como la nebulización en el tratamiento de las crisis asmáticas en la infancia. No existe consenso sobre cuál es la equivalencia de dosis entre ambos sistemas de inhalación. Objetivo. Determinar la eficacia de diferentes dosis de salbutamol o terbutalina administrados mediante dispositivo MDI con cámara espaciadora, en el tratamiento de la crisis asmática en urgencias. Métodos. Estudio prospectivo, aleatorio y ciego. Fueron incluidos de forma consecutiva, todos los niños entre 2 y 14 años que consultaron por una crisis asmática en el servicio de urgencias entre el 1 de octubre y el 30 de noviembre de 2004. Se establecieron dos grupos de tratamiento: un grupo recibió un número de puffs equivalente a la mitad del peso del niño (1 puff de salbutamol = 100 μg y 1 puff de terbutalina = 250 μg) y el segundo grupo recibió un número de puffs equivalente a un tercio del peso. Resultados. Fueron estudiados 324 episodios; 164 niños en el primer grupo y 160 en el segundo grupo. La edad media de ambos grupos fue similar (58,34 ± 34,72 meses frente a 66,04 ± 36,45 meses), y no se encontraron diferencias significativas en la saturación de oxígeno (95,49 ± 1,93 frente a 95,56 ± 1,97), ni en la puntuación del pulmonary score (PS) (4,04 ± 1,55 frente a 3,97 ± 1,51) en el momento de la llegada a urgencias, ni tras el tratamiento administrado, saturación de oxígeno (96,34 ± 1,60 frente a 96,18 ± 1,77) y puntuación del PS (1,87 ± 1,33 frente a 1,64 ± 1,31). El número de dosis de broncodilatador administradas fue similar en ambos grupos (2,17 ± 0,91 frente a 2,24 ± 1,00). No se observaron diferencias en el porcentaje de niños que precisaron ingreso en la unidad de observación (8,56 % frente a 6,87 %). Conclusiones. Las diferentes dosificaciones de broncodilatadores administradas a través de MDI con espaciador, utilizadas en este estudio, tuvieron una eficacia similar. Estos hallazgos deberían contribuir a reconsiderar el uso de dosis elevadas de broncodilatadores, al menos en la mayoría de las crisis asmáticas en niños

Introduction. Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage. Objective. To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department. Methods. This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child's weight (1 puff of salbutamol = 100 μg and 1 puff of terbutaline = 250 μg) and the other group received a number of puffs equivalent to one-third of the child's weight. Results. Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (6 SD) age (58.34 ± 34.72 vs 66.04 ± 36.45 months), arterial oxygen saturation (95.49 ± 1.93 vs 95.56 ± 1.97) or pulmonary score (4.04 ± 1.55 vs 3.97 ± 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 ± 1.60 vs 96.18 ± 1.77], pulmonary score [1.87 ± 1.33 vs 1.64 ± 1.31]). The number of doses administered (2.17 ± 0.91 vs 2.24 ± 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups. Conclusions. The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children

[Telephone triage performed by emergency room physicians]. / Triage telefónico realizado por médicos en urgencias de pediatría.

OBJECTIVE: To determine the applicability and utility of a telephone triage performed by physicians in a pediatric emergency department (PED). PATIENTS AND METHOD: All the telephone consultations registered between 2003-10-1 and 2004-10-3 were reviewed. The variables analyzed were: telephone call record (n = 2,560), compliance with the advice given (randomized sample of patients who were not referred to the PED and all patients who were referred) and parent satisfaction (callers over a 1-month period were contacted). A protocol for answering queries was organized and residents received specific training. RESULTS: There were 59,088 episodes and 2,560 calls were registered (1 call/23 episodes). Forty-eight percent of the calls were received between 5 and 11 pm. All calls were answered by a physician (72% residents, 28% attending physicians). The most frequent reason for calling was to seek advice on symptoms. Eighty-two percent of the calls were resolved through telephone instructions to be carried out in the home. A total of 274 patients were advised to attend the PED, but 29% did not attend, usually because the child's symptoms improved. Twenty patients were admitted to the hospital (6 to wards, 14 to the observation unit). Of the patients not advised to attend, 21% attended the PED and 0.9% were admitted (compared with 7.2% in the referral group, p = 0.0001). More than 90% of the families questioned were satisfied with the advice given. Seventy-five percent would have attended the PED if telephone consultation had not been available. By giving telephone advice, we avoided 115 visits in 1 month. COMMENTS: If special training programs and answering systems are established after a training period, telephone consultation in a PED is a safe and useful method of performing patient triage. Satisfaction among families was high.

Triage telefónico realizado por médicos en urgencias de pediatría / Telephone triage performed by emergency room physicians

Objetivo: Comprobar la aplicabilidad de un triage telefónico realizado por médicos en un servicio de urgencias de pediatría (SUP). Pacientes y método: Se estudian las consultas telefónicas en un SUP entre el 1-10-2003 y el 3-10-2004, analizando: registro de llamadas (n = 2.560); cumplimiento de las recomendaciones (los que recibieron instrucción de acudir y muestra aleatoria de los que no recibieron consejo de acudir), y satisfacción de los padres (encuesta telefónica durante un mes). Se estableció un protocolo de respuesta y los MIR (médicos internos residentes) recibieron formación específica. Resultados: Se registraron 59.088 episodios y 2.560 llamadas (1 llamada/23 episodios). El 48 % se recibieron entre las 17 y las 23 h. Todas las llamadas fueron contestadas por un médico (72 % MIR; 28 % adjunto) El motivo de llamada más frecuente fue la consulta sobre síntomas. El 82 % de las consultas fueron resueltas mediante instrucciones de tratamiento domiciliario. Se recomendó acudir al SUP a 274 pacientes. De éstos, el 29 % no acudió, la mayoría por mejoría de los síntomas. Precisaron ingreso en el hospital 20 pacientes (6 en planta, 14 en observación). Del grupo al que no se recomendó acudir para valoración, el 21 % acude e ingresa el 0,9 % (frente a 7,2 % del grupo derivado; p = 0,0001). De las familias encuestadas, más del 90 % describió como útil el consejo recibido. El 75 % habría acudido a nuestro servicio de no existir la posibilidad de consultar telefónicamente. En un mes se habrían evitado 115 visitas. Discusión: Realizada tras un período formativo y de forma protocolizada la consulta telefónica en un SUP es una herramienta segura y útil para el triage, con un alto grado de satisfacción de las familias

Objective: To determine the applicability and utility of a telephone triage performed by physicians in a pediatric emergency department (PED). Patients and method: All the telephone consultations registered between 2003-10-1 and 2004-10-3 were reviewed. The variables analyzed were: telephone call record (n = 2,560), compliance with the advice given (randomized sample of patients who were not referred to the PED and all patients who were referred) and parent satisfaction (callers over a 1-month period were contacted). A protocol for answering queries was organized and residents received specific training. Results: There were 59,088 episodes and 2,560 calls were registered (1 call/23 episodes). Forty-eight percent of the calls were received between 5 and 11 pm. All calls were answered by a physician (72 % residents, 28 % attending physicians). The most frequent reason for calling was to seek advice on symptoms. Eighty-two percent of the calls were resolved through telephone instructions to be carried out in the home. A total of 274 patients were advised to attend the PED, but 29 % did not attend, usually because the child's symptoms improved. Twenty patients were admitted to the hospital (6 to wards, 14 to the observation unit). Of the patients not advised to attend, 21 % attended the PED and 0.9 % were admitted (compared with 7.2 % in the referral group, p = 0.0001). More than 90 % of the families questioned were satisfied with the advice given. Seventy-five percent would have attended the PED if telephone consultation had not been available. By giving telephone advice, we avoided 115 visits in 1 month. Comments: If special training programs and answering systems are established after a training period, telephone consultation in a PED is a safe and useful method of performing patient triage. Satisfaction among families was high

Estudio clínico y epidemiológico de la neumonía adquirida en la comunidad en niños menores de 5 años de edad / Clinical and epidemiological study of community-acquired pneumonia in children aged less than 5 years old

Objetivo: Conocer la forma de presentación clínica y morbilidad de la neumonía adquirida en la comunidad, en niños menores de 5 años. Pacientes y método: Estudio epidemiológico, prospectivo, realizado en 12 centros de atención primaria (CAP) de la provincia de Vizcaya, y en los Servicios de Urgencias Hospitalarias de los Hospitales de Basurto y Cruces (provincia de Vizcaya). En el momento del diagnóstico se recogieron datos demográficos, clínicos, radiológicos y analíticos y del tratamiento. Se estableció una clasificación del tipo de neumonía, desde neumocócica definitiva (aislado del microorganismo en un líquido habitualmente estéril), hasta neumonía de improbable origen neumocócico, basándose en el patrón radiológico de la neumonía (patrón lobular), el número de cifra de leucocitos (> 15.000/μl) y el valor de la proteína C reactiva (PCR > 80 mg/l). Entre los 7 y 15 días del diagnóstico se realizó un control del paciente para comprobar la evolución del proceso. Resultados: Entre febrero y abril de 2003 se incluyeron en el estudio 412 niños con neumonía. La edad media de los pacientes fue de 33,4 ± 15,34 meses y el 21 % había recibido alguna dosis de la vacuna conjugada neumocócica. El 20 % de los niños presentaba afectación del estado general y el 14,6 % precisó hospitalización, con una estancia media de 4,10 ± 2,21 días. El promedio de visitas a su pediatra de CAP fue de 2,06 ± 1,10 y la duración media del tratamiento fue de 9,51 ± 2,44 días. Un total de 53 pacientes (12,9 %) presentaron una neumonía neumocócica definitiva o muy probable; estos niños mostraron de manera significativa mayor elevación de la temperatura (38,74 ± 0,84 °C frente a 38,38 ± 0,94 °C), un porcentaje mayor de afectación del estado general (50,9 % frente a 15,3 %) y una tasa más elevada de hospitalización (41,5 % frente a 10,5 %). Conclusiones: La neumonía adquirida en la comunidad, en niños menores de 5 años, presenta una elevada morbilidad. Utilizando parámetros clínicos, analíticos y radiológicos, la neumonía que se sospecha de origen neumocócico, parece más grave que las de otras posibles etiologías

Objective: To describe the clinical characteristics of community-acquired pneumonia and associated morbidity in children under 5 years old. Patients and method: We performed a prospective epidemiological study in 12 primary care clinics and two pediatric emergency departments in Vizcaya, Spain. Demographic, clinical, radiological, laboratory and treatment data were recorded at diagnosis. Different pneumonia groups were established on the basis of radiological images (lobar pattern), total leucocyte count (> 15.000/ml) and C-reactive protein value (> 80 mg/l). These groups ranged from definitive pneumococcal pneumonia (pneumococcus isolated in usually sterile specimens) to pneumonia of probable non-pneumococcal etiology. All patients were followed-up for 7 to 15 days after diagnosis to ascertain outcome. Results: Between February and April 2003, 412 children with pneumonia were enrolled. The mean age was 33.4 6 15.34 months and 21 % of the patients had received the pneumococcal conjugate vaccine. Overall 20 % had general malaise and 14.6 % required admission, with a mean length of hospital stay of 4.10 ± 2.21 days. The mean length of treatment was 9.51 ± 2.44 days and the mean number of visits to the primary care pediatrician was 2.02 6 1.10. Fifty-three patients (12.9 %) had definitive or highly probable pneumococcal pneumonia and these children had higher temperature (38.74 ± 0.84 vs 38.38 ± 0.94 °C), a higher percentage of general malaise (50.9 % vs 15.3 %) and a higher hospitalization rate (41.5 % vs 10.5 %). Conclusions: Community-acquired pneumonia in children under 5 years old provokes high morbidity. According to clinical, radiological and laboratory data, suspected pneumococcal pneumonia seems more severe than forms probably caused by other agents

[Clinical and epidemiological study of community-acquired pneumonia in children aged less than 5 years old]. / Estudio clínico y epidemiológico de la neumonía adquirida en la comunidad en niños menores de 5 años de edad.

OBJECTIVE: To describe the clinical characteristics of community-acquired pneumonia and associated morbidity in children under 5 years old. PATIENTS AND METHOD: We performed a prospective epidemiological study in 12 primary care clinics and two pediatric emergency departments in Vizcaya, Spain. Demographic, clinical, radiological, laboratory and treatment data were recorded at diagnosis. Different pneumonia groups were established on the basis of radiological images (lobar pattern), total leucocyte count (> 15,000/ml) and C-reactive protein value (> 80 mg/l). These groups ranged from definitive pneumococcal pneumonia (pneumococcus isolated in usually sterile specimens) to pneumonia of probable non-pneumococcal etiology. All patients were followed-up for 7 to 15 days after diagnosis to ascertain outcome. RESULTS: Between February and April 2003, 412 children with pneumonia were enrolled. The mean age was 33.4 6 15.34 months and 21 % of the patients had received the pneumococcal conjugate vaccine. Overall 20 % had general malaise and 14.6 % required admission, with a mean length of hospital stay of 4.10 +/- 2.21 days. The mean length of treatment was 9.51 +/- 2.44 days and the mean number of visits to the primary care pediatrician was 2.02 6 1.10. Fifty-three patients (12.9 %) had definitive or highly probable pneumococcal pneumonia and these children had higher temperature (38.74 +/- 0.84 vs 38.38 +/- 0.94 degrees C), a higher percentage of general malaise (50.9 % vs 15.3 %) and a higher hospitalization rate (41.5 % vs 10.5 %). CONCLUSIONS: Community-acquired pneumonia in children under 5 years old provokes high morbidity. According to clinical, radiological and laboratory data, suspected pneumococcal pneumonia seems more severe than forms probably caused by other agents.

[Infants aged 3-24 months with fever without source in the emergency room: characteristics, management and outcome]. / Lactante de 3-24 meses con fiebre sin foco en urgencias: características, tratamiento y evolución posterior.

OBJECTIVE: To determine the characteristics of infants aged 3-24 months admitted to a Hospital Pediatric Emergency Room with fever without source, the management of these infants and their subsequent outcome. PATIENTS AND METHOD: We performed a retrospective survey of 733 children aged 3-24 months with fever without source admitted to our Emergency Room between September 1, 2003 and December 31, 2003. Subsequently, the parents of all infants diagnosed with fever without source who were managed as outpatients were telephoned to ascertain their outcome and changes in the final diagnosis. RESULTS: Onset of fever occurred less than 6 hours before arrival at the hospital in 237 episodes (32.2%). The family reported a temperature of > or = 39 degrees C in 436 episodes. Diagnoses in the Emergency Room were the following: fever without source in 677 (92.3%), urinary tract infection in 53 (7.2%) and bacterial meningitis in three (0.4 %). Fifty-five infants with an altered dipstick were excluded and complete blood count (CBC) and blood culture were performed in 66 infants (9.7%). There was a significant negative association between the probability of a request for CBC and blood culture and higher age [6-11 months vs. 3-6 months OR 0.24 (95 % CI: 0.11-0.49); > or = 12 months vs. 3-6 months, OR 0.15 (0.07-0.3)] and a significant positive association with onset more than 12 hours previously [vs. less than 6 hours OR 2.3 (1.2-4.43)] and highest temperature registered at home > 40 degrees C [vs. less than 39 degrees C OR 4.22 (1.5-11.84)]. Follow-up was completed (by telephone or readmission to the Emergency Room) in 574 infants diagnosed with fever without source and managed as outpatients. The final diagnosis differed from that made in the Emergency Room in 158 infants (27.5%), and 70 received antibiotics (12.1%). CONCLUSIONS: A considerable percentage of infants aged 3-24 months with fever without source visits the Emergency Room with very short-term processes. Patient observation is very useful in the management of these infants, since the final diagnosis differed from that made in the emergency room in nearly 30% and 12% were treated with antibiotics.

Lactante de 3-24 meses con fiebre sin foco en urgencias: características, tratamiento y evolución posterior / Infants aged 3-24 months with fever without source inthe emergency room: characteristics, management and outcome

Objetivo: Conocer las características de los lactantes de 3-24 meses que consultaron en una unidad de urgencias pediátrica hospitalaria con fiebre sin focalidad, su tratamiento y evolución posterior. Pacientes y método: Estudio retrospectivo de los 733 episodios correspondientes a los lactantes de 3 a 24 meses que consultaron por fiebre sin focalidad entre el 1 de septiembre y el 31 de diciembre de 2003. Posteriormente se contactó telefónicamente con los diagnosticados de síndrome febril sin focalidad y tratados ambulatoriamente, para conocer su evolución y diagnóstico final. Resultados: El tiempo de evolución de la fiebre hasta la consulta fue inferior a 6 h en 237 episodios (32,2 %). En 436 casos la familia refirió una temperatura mayor o igual a 39 °C. Los diagnósticos fueron: síndrome febril sin focalidad, 677 (92,3 %); infección del tracto urinario, 53 (7,2 %), y meningitis bacteriana, 3 casos (0,4 %). Excluidos los 55 niños con tira reactiva de orina alterada, se practicó analítica sanguínea y hemocultivo a 66 (9,7 %). La probabilidad de solicitar analítica se asoció negativa y significativamente con: mayor edad (6-11 meses frente a 3-6 meses; odds ratio [OR], 0,24; intervalo de confianza [IC] del 95 %, 0,11-0,49; >= 12 meses frente a 3-6 meses; OR, 0,15 [límites, 0,07-0,3]); y positivamente con mayor tiempo de evolución superior a 12 h (frente a < 6 h; OR, 2,3 [límites, 1,2-4,43]); y temperatura máxima registrada en casa superior a 40 °C (frente a < 39 °C; OR, 4,22 [límites, 1,5-11,84]). En 574 niños diagnosticados de síndrome febril sin focalidad que siguieron tratamiento ambulatorio se completó el seguimiento (telefónicamente o por readmisión en urgencias), variando el diagnóstico en 158 (27,5 %), y recibieron antibiótico 70 (12,1 %). Conclusiones: Un porcentaje importante de lactantes de 3-24 meses con fiebre sin focalidad consulta por procesos muy recortados. La observación continuada es un instrumento capital del tratamiento de los lactantes con síndrome febril sin focalidad, ya que alrededor del 30 % reciben un diagnóstico final diferente al inicial y el 12 %, tratamiento antibiótico

Objective: To determine the characteristics of infants aged 3-24 months admitted to a Hospital Pediatric Emergency Room with fever without source, the management of these infants and their subsequent outcome. Patients and method: We performed a retrospective survey of 733 children aged 3-24 months with fever without source admitted to our Emergency Room between September 1, 2003 and December 31, 2003. Subsequently, the parents of all infants diagnosed with fever without source who were managed as outpatients were telephoned to ascertain their outcome and changes in the final diagnosis. Results: Onset of fever occurred less than 6 hours before arrival at the hospital in 237 episodes (32.2 %). The family reported a temperature of >= 39 °C in 436 episodes. Diagnoses in the Emergency Room were the following: fever without source in 677 (92.3 %), urinary tract infection in 53 (7.2%)and bacterial meningitis in three (0.4 %). Fifty-five infants with an altered dipstick were excluded and complete blood count (CBC) and blood culture were performed in 66 infants (9.7 %). There was a significant negative association between the probability of a request for CBC and blood culture and higher age [6-11 months vs. 3-6 months OR 0.24 (95 % CI: 0.11-0.49); >= 12 months vs. 3-6 months, OR 0.15 (0.07-0.3)] and a significant positive association with onset more than 12 hours previously [vs. less than 6 hours OR 2.3 (1.2-4.43)] and highest temperature registered at home > 40 °C [vs. less than 39 °C OR 4.22 (1.5-11.84)]. Follow-up was completed (by telephone or readmission to the Emergency Room) in 574 infants diagnosed with fever without source and managed as outpatients. The final diagnosis differed from that made in the Emergency Room in 158 infants (27.5 %), and 70 received antibiotics (12.1 %). Conclusions: A considerable percentage of infants aged 3-24 months with fever without source visits the Emergency Room with very short-term processes. Patient observation is very useful in the management of these infants, since the final diagnosis differed from that made in the emergency room in nearly 30 % and 12% were treated with antibiotics

Demanda y asistencia en un servicio de urgencias hospitalario / Patient demand and management in a hospital pediatric emergency setting

Objetivo: Estudiar la demanda y la asistencia en una Unidad de Urgencias de Pediatría hospitalaria. Pacientes y método: Se analiza la evolución del número de episodios registrados en Urgencias de Pediatría entre 1995 y 2002 y se realiza un estudio retrospectivo aleatorio de 540 episodios correspondientes a niños menores de 14 años entre el 1 de octubre de 2001 y el 30 de septiembre de 2002. Se recogen datos sociodemográficos y del episodio, hallazgos exploratorios, pruebas complementarias, tratamiento administrado, destino de los pacientes y reconsulta. Resultados: Entre el 1 de enero de 1995 y el 31 de diciembre de 2002, se registraron 337.842 episodios en la Unidad de Urgencias, precisando ingreso en planta o Unidad de Cuidados Intensivos Pediátricos (UCIP) 11.767 (3,48 por ciento). El número de episodios/año registrados pasó de 38.659 en 1995 a 51.933 en 2002 (Delta= 34,3 por ciento). La edad media de la muestra estudiada (n= 540) fue 3,5+/- 3,2 años (54,6 por ciento menores de 3 años), que se distribuyeron en 306 (56 por ciento) varones. Cerca de un tercio consultó por cuadros de menos de 6 h de evolución. Los motivos de consulta más frecuentes fueron fiebre en 160 (29,6 por ciento), dificultad respiratoria en 78 (14,4 por ciento) y vómitos-diarrea en 65 (12 por ciento). Se practicaron pruebas a 176 (32,6 por ciento), fundamentalmente radiológicas (115; 21,2 por ciento). Recibieron tratamiento en urgencias 153 casos (28,3 por ciento), sobre todo antitérmicos y broncodilatadores. El 65 por ciento permaneció menos de 1 h en Urgencias. Los diagnósticos principales fueron síndrome febril en 66 (12,2 por ciento), diarrea/gastroenteritis aguda en 40 (7,4 por ciento), asma en 35 (6,5 por ciento), laringitis en 27 (5 por ciento). Ingresaron en planta 16 niños (3 por ciento) y 3 (0,6 por ciento) en la UCIP. Se recomendó tratamiento farmacológico domiciliario a 359 (71,8 por ciento). Reconsultaron 59 pacientes (10,9 por ciento), e ingresaron 5 casos. Conclusiones: El número de pacientes atendidos entre 1995 y 2002 en la Unidad de Urgencias de Pediatría ha crecido de manera paulatina por lo general por niños pequeños con cuadros febriles recortados o dificultad respiratoria. En la mitad de los casos una correcta anamnesis y exploración física fueron suficientes para manejar a estos niños. La corta evolución de muchos procesos hacen de la observación continuada, ya domiciliaria o intrahospitalaria, una herramienta importante en el correcto seguimiento de nuestros pacientes (AU)

[Patient demand and management in a hospital pediatric emergency setting]. / Demanda y asistencia en un servicio de urgencias hospitalario.

OBJECTIVE: To describe patient demand and management in a hospital pediatric emergency setting. PATIENTS AND METHOD: We analyzed the number of episodes registered in our pediatric emergency unit between 1995 and 2002 and performed a retrospective, random survey of 540 episodes in children aged less than 14 years admitted between 2001-10-1 and 2002-09-30. Epidemiological details, physical findings, complementary tests, the treatment administered, admissions, and unscheduled return visits were analyzed. RESULTS: Between 1995-1-01 and 2002-31-12, a total of 337,842 episodes were registered in our emergency unit, requiring 11,767 (3.48 %) admissions to a ward or the pediatric intensive care unit (PICU). The number of episodes/ year increased from 38,659 in 1995 to 51,933 in 2002 (Delta = 34.3 %). The mean age of the sample (n = 540) was 3.5 6 3.2 years (54.6 % were younger than 3 years) and 306 (56 %) were boys. Nearly one-third of the children presented with processes of recent onset (less than 6 hours). The most frequent chief complaints were fever in 160 children (29.6 %), respiratory distress in 78 (14.4 %) and vomiting-diarrhea in 65 (12 %). Complementary investigations were performed in 176 patients (32.6 %), mainly radiologic tests (115; 21.2 %). One hundred fifty-three (28.3 %) received treatment in our emergency unit, mainly antipyretics and bronchodilators. Sixty-five percent stayed less than 1 hour in the emergency unit. The most frequent diagnoses were fever without source in 66 patients (12.2 %), diarrhea/acute gastroenteritis in 40 (7.4 %), asthma in 35 (6.5 %), and croup in 27 (5 %). Sixteen children (3 %) were admitted to a ward and three (0.6 %) were admitted to the PICU. Home drug treatment was recommended in 359 patients (71.8 %). Unscheduled return visits were registered in 59 patients (10.9 %), and five were admitted. CONCLUSIONS: The number of patients attended in our pediatric emergency unit gradually increased between 1995 and 2002, mostly due to young children with fever or respiratory distress. In nearly half of the patients, a thorough anamnesis and physical examination were sufficient for evaluation. Because many of the processes were of recent onset, continuous observation, whether at home or in hospital, was useful to adequately monitor these children.