Applying the Ottawa Ankle Rules in a Pediatric Emergency Department.

OBJECTIVES: Ankle and midfoot injuries constitute one of the most frequent reasons to visit the pediatric emergency department (ED). The aims of the study were (1) to determine the feasibility of the Ottawa Ankle Rules (OARs) in a pediatric ED and its reliability to safely manage ankle and midfoot injuries and (2) to verify the impact in reducing the number of radiographs, healthcare costs, and time spent in the ED. METHODS: The prospective study enrolled 90 patients for the control group and 94 for the case group. For the control group, the standard of practice was registered. In the case group, before beginning enrolment, an instruction of how to apply the OARs were given to all clinicians. After that, OARs were applied according to patient complaints. A follow-up call was made for both groups. RESULTS: The mean age of the control group was 11.9 years (standard deviation, 3.267 years), whereas in the case group was 11.3 years (standard deviation, 3.533 years). Demographic and injury characteristics were similar in both groups. A significant statistical difference was verified in the number of radiographs (P = 0.001) with a reduction of 16.7% in the case group. Patients who did not perform radiography, in the case group, spent at least 1 hour less than the ones who did. The OARs have shown a sensitivity of 100% (95% confidence interval, 39.76-100.00) and specificity of 23.33% (95% CI, 15.06-33.43) with a negative predictive value of 100%. CONCLUSIONS: The OARs are an important clinical instrument with a high sensitivity and negative predictive value, which allows clinicians to avoid unnecessary exposure to radiation without missing clinically relevant fractures.

The Impact of the COVID-19 Pandemic on Children's Health in Portugal: The Parental Perspective.

INTRODUCTION: The COVID-19 pandemic poses unprecedented challenges for healthcare services and has led to changes in the usage pattern of the pediatric population. We aimed to describe the impact of COVID-19 on children's health, wellbeing, and access to medical care in Portugal. MATERIAL AND METHODS: We conducted a cross-sectional study through an anonymous online survey via social media. The collected data refers to a period between the 16th of March and the 17th of May 2020. RESULTS: We obtained responses to the survey on 19 745 children. Of the previously scheduled outpatient consultations, 54.2% were postponed by healthcare institutions and 21.6% of planned vaccinations were missed. Parents expressed concerns regarding psychological, social, and physical consequences for their children due to the pandemic. DISCUSSION: The observed reduction of pediatric emergency department visits and the postponement of outpatient consultations and vaccine administrations are potentially harmful for non-COVID patients. The current pandemic and the imposed social distance might have an important negative impact on the mental health of children. CONCLUSION: Further studies are necessary to fully comprehend the outcomes of the decreased access to medical care, as well as the collateral damage for children beyond the clinical aspects of the pandemic. Defining strategies regarding the urge to vaccinate children and not postpone urgent evaluations should be a public health priority.

Introdução: A pandemia COVID-19 constitui um desafio sem precedentes para os serviços de saúde e conduziu a alterações no padrão de utilização dos recursos pela população pediátrica. Procurámos descrever o impacto da pandemia COVID-19 na saúde infantil e no acesso à saúde em Portugal. Material e Métodos: Realizámos um estudo retrospetivo, recolhendo dados através da aplicação de um inquérito anónimo online nas redes sociais. Os dados referem-se ao período entre 16 de março e 17 de maio de 2020. Resultados: Obtivemos respostas ao inquérito relativas a 19 745 crianças. Da análise às respostas, concluímos que 54,2% das consultas previamente agendadas foram adiadas pelas instituições de saúde e 21,6% das vacinações previstas não se realizaram. Os pais expressaram preocupação quanto às consequências psicológicas, sociais e físicas da pandemia nos seus filhos. Discussão: A reduzida utilização dos serviços de urgência pediátricos, bem como a não realização de consultas e vacinações previamente agendadas é potencialmente lesiva para os doentes não-COVID. A pandemia e o isolamento social imposto poderão causar um impacto negativo na saúde mental das crianças. Conclusão: Estudos adicionais são necessários para melhor compreender as consequências da diminuição do acesso à saúde, bem como os efeitos psicológicos, sociais e físicos nas crianças. A definição de estratégias para incentivar a vacinação e o não adiamento de avaliações médicas urgentes deveriam ser prioridades de Saúde Pública.

Oral language in children with benign childhood epilepsy with centrotemporal spikes.

PURPOSE: Benign childhood epilepsy with centrotemporal spikes is one of the most common childhood disorders. Despite the benignity usually attributed to this epileptic syndrome, several studies have demonstrated that these children have cognitive disabilities. Among these disturbances, language disorders have been the less studied in depth. We aimed to obtain accurate information about the language skills of children with this epileptic syndrome and to explore the correlation between demographic and clinical factors associated with epilepsy and the language skills. METHODS: We assessed 30 children with this epileptic syndrome, followed in three hospitals in Lisbon, and 60 controls, aged between 6 and 12 years, attending the same schools and matched by age, gender, and parents' socioprofessional level. All the included children did not present cognitive impairment (reasoning ability, verbal memory), sensory, or motor limitations. The evaluation tests covered all language areas. RESULTS: Overall, children with this epileptic syndrome had lower skills in the majority of the language areas, when compared with their peers. These children showed greater difficulties in semantics and syntax domains. The atypical evolution of the seizures and a longer duration of epilepsy were the clinical variables that most influence the language skills of our samples. CONCLUSION: The early assessment of these capacities and the possible need for therapeutic intervention should be emphasized, in order to minimize the impact on their academic performance and quality of life.

Children Who Leave the Emergency Department Without Being Seen: Why Did They Leave and What Would Make Them Stay?

INTRODUCTION: Children who visit emergency departments and leave without being seen represent a multifactorial problem. We aimed to compare the sociodemographic characteristics of children who left and of those who did not leave, as well as to evaluate parental reasoning, subsequent use of medical care and patient outcome. MATERIAL AND METHODS: This was a prospective case-control study of a random sample of children who left without being seen and their matched controls from an emergency department during a three-month period. We performed a phone questionnaire to obtain information concerning reasons for leaving, patient outcomes and general feedback. RESULTS: During the study period, 18 200 patients presented to the emergency department, of whom 92 (0.5%) left without being seen. Fifty-five (59.8%) completed the questionnaire and there were 82 controls. The most common reasons for leaving were 'excessive waiting time' (92.7%) and 'problem could wait' (21.8%). A significantly higher number of patients who left sought further medical care (78.2% vs 11%) but they did not experience higher levels of unfavourable outcomes. DISCUSSION: The waiting time seems to be the major factor that drives the decision to leave. The fact that parents felt safe in leaving and the low level of adverse outcomes highlights the low-acuity nature of the majority of patients who leave. CONCLUSION: Reducing the waiting times may be the logical strategic mean to decrease the rates of patients who leave without being seen. However, our data seems to indicate that the concerns surrounding clinical outcome after leaving may be partly unwarranted.

Introdução: O abandono de doentes do serviço de urgência pediátrico antes da observação médica constitui um problema multifatorial. Procurámos comparar características sociodemográficas de crianças que abandonaram a urgência e das que não abandonaram, assim como avaliar os motivos, recurso subsequente a cuidados de saúde e outcome clínico. Material e Métodos: Estudo caso-controlo prospetivo de amostra aleatória de crianças que abandonaram a urgência e de controlos pareados durante um período de três meses. Foi realizado um questionário telefónico para recolha de informação relacionada com os motivos para o abandono, outcomes clínicos e opiniões gerais. Resultados: Durante o período do estudo, 18 200 doentes recorreram ao Serviço de Urgência Pediátrica, dos quais 92 (0,5%) abandonaram. Um total de 55 casos (59,8%) e 82 controlos completaram o questionário. As razões mais comuns para o abandono foram 'tempo de espera excessivo' (92,7%) e 'problema podia esperar' (21,8%). Um número significativamente superior de doentes que abandonaram recorreu subsequentemente a cuidados de saúde (78,2% vs 11%), não tendo contudo apresentado uma incidência superior de outcomes adversos. Discussão: O tempo de espera parece ser o fator prioritário que motiva a decisão de abandonar a urgência. A segurança referida pelos pais aquando da decisão e a incidência reduzida de outcomes adversos parecem reforçar a noção de que se trata de doentes com casos clínicos de baixa gravidade. Conclusão: A redução do tempo de espera parece ser a medida estratégica lógica para diminuir as taxas de abandono. No entanto, a preocupação associada ao outcome clínico após o abandono poderá ser parcialmente injustificada.

Palmar rash in a teenager: more than meets the eye.

Despite being an uncommon disease in pediatrics, the incidence of syphilis has increased in the last years both in Europe and in the United States. Upon a suggestive clinical presentation, especially if including genital lesions and palmar rash, secondary syphilis must be included in the differential diagnosis.

[Assessment of severity of meningococcal sepsis in children]. / Avaliação da gravidade da sépsis meningocócica em crianças.

Despite advances in critical care medicine, acute meningococcal infection remains complicated by high mortality. Different prognostic scoring systems have been developed but none of them is largely used. The objective of this study was to evaluate the performance at admission to the pediatric intensive care unit (PICU) of five severity scores in children with proven and unproven meningococcal infection. Our results seem to indicate that the Neisseria Sepsis Index (NESI) and the Rotterdam Score (RS) perform better than the other scores, being appropriate tools to assess severity of illness at admission to the PICU in children with proven or presumed meningococcal infection.

[Poisoning with methanol and carbamates]. / Intoxicação com metanol e carbamatos.

We describe the case of a eleven years old boy with a simultaneous intentional poisoning with methanol and carbamates. The symptomatology was biphasic due to the addition of the symptomatology of both intoxications. Therapeutic measures included gastrointestinal decontamination, sodium bicarbonate, atropine, ethanol administration and hemodialysis.