[Paediatric neurology health care activity in a tertiary hospital. A study comparing it with adult neurology and non-neurological paediatrics]. / Actividad asistencial de la neurología pediátrica en un hospital de nivel 3. Estudio comparativo con la neurología de adultos y la pediatría no neurológica.

INTRODUCTION: Paediatric neurology (PN) remains 'hidden' somewhere between paediatrics and neurology in almost all health care centres and this makes it difficult to allocate resources in a proper manner. AIMS: Our objective in this study was to analyse PN health care activity and compare it with adult neurology (AN) and with non-neurological paediatrics (NNP). MATERIAL AND METHODS: PN health care activity registry for the year 2002. AN and NNP data were collected from the hospital's Computer Service. RESULTS: In all, 1300 PN visits were made, 428 of which were new and 872 successive, which represent 16.2% of paediatric visits (30% new, 13.3% successive) and 10.3% of neurological visits (12.4% new, 10.2% successive). The rates of new and successive visits in PN are: 32.6, 10.7 and 21.9 per 1000 children, and in AN: 44.2, 12.5 and 31.7 per 1000 adults. A total number of 94 hospitalised children were attended, 3.3% of all paediatric admissions and 9.2% of the total neurological attention in inpatients. The rates are 2.36 per 1000 children in PN and 3.9 per 1000 adults in AN. There is greater demand among smaller children. The most frequent pathologies are headaches in clinical visits and epilepsy in hospitalised patients. CONCLUSIONS: PN is essentially a service used by outpatients. It accounts for a high percentage of hospital paediatric visits. The activity rates per 1000 children and per 1000 adults are similar. The increased birth rate raises PN activity to a level that is higher than would normally be desirable, due to the growth in the population.

[The present state of paediatric neurology in the Autonomous Community of Madrid: variability in the distribution of resources]. / Situacion de la neurologia pediatrica en la Comunidad Autonoma de Madrid: variabilidad en la distribucion de los recursos.

INTRODUCTION: Paediatric neurology (PN) lies halfway between neurology and paediatrics, with no official acknowledgment. It is therefore difficult to determine exactly how resources are shared out. AIMS: The aim of this study is to analyse the public resources devoted to PN in the different health care areas within the Autonomous Community of Madrid (ACM). MATERIALS AND METHODS: In May 2002 we carried out a survey among child neurologists (CN) from the 9 independent health care districts within the ACM. RESULTS: A total of 28 CN work for the public health service in the ACM, eight of whom are employed on a part time basis. Only 53% are owners. The ratio of CN per 100000 inhabitants (inhab.) is 0.55 (0.45 after correction for part time work). The figure varies from one area to another from 0.07 to 1 CN/100000 inhab. (1/12000 1/220000 children). Part time neurologists work in the outer districts of the ACM. In most areas it is difficult to carry out diagnostic tests and these become even complicated when the child is small and requires some anaesthetic procedure. Neuropsychological assessment is one of the basic evaluations performed in PN and this is not easily performed in most centres. CONCLUSIONS: The CN/100000 inhab. ratio in the ACM is lower than that commonly recommended. The distribution of resources varies greatly and does not match demographic criteria. Temporary and part time jobs are commonplace in the peripheral areas. It is difficult for most centres to perform diagnostic tests.