[Do paediatricians perform lumbar puncture correctly? Review of recommendations and analysis the technique in Spain]. / ¿Se realiza correctamente la punción lumbar en pediatría? Revisión de las recomendaciones actuales y análisis de la realidad.

INTRODUCTION: Lumbar puncture (LP) is a commonly performed procedure in paediatrics. Performing this technique properly can avoid the most common associated complications. OBJECTIVE: To assess whether paediatricians and paediatric residents in Spain follow current recommendations for the LP technique. MATERIAL AND METHODS: A cross-sectional study was conducted by sending a questionnaire by mail through the Spanish Society of Paediatric Emergencies, collecting demographic information and responses to multiple choice questions about LP technique. RESULTS: A total of 206 questionnaires were analysed, of which 143 (69.5%) were answered by paediatricians, and 63 (30.5%) by paediatric residents. The majority (128; 62.1%) of physicians did not allow parents to be present during LP, 198 (96.1%) routinely use analgesia and sedation; 84 (42%) only used local anaesthesia. The majority of respondents used standard Quincke needles (126; 62.7%). The bevel was correctly positioned when puncturing the dura mater by 22 residents (36.1%) and 21 paediatricians (15.1%), a variation that was statistically significant (P=.001). For neonatal lumbar punctures, 63 paediatricians (46%) and 19 paediatric residents used a butterfly needle which did not contain a stylet, and this difference was also statistically significant (P=.035). Of those surveyed, 190 (92.2%) re-inserted the stylet when re-orientating the needle, and 186 (93%) re-oriented this when removing it. The recommendation of bed rest was made by 195 (94.7%) physicians. CONCLUSIONS: The majority of paediatricians orient the bevel wrongly when inserting the needle during LP, and still use "butterfly" needles in newborns, despite warnings to the contrary. Paediatric residents and less experienced paediatricians follow the recommendations more frequently.

[Complications of bladder catheterization to obtain a urine sample in the emergency department]. / Complicaciones del cateterismo vesical realizado en un servicio de urgencias para obtener una muestra de orina.

INTRODUCTION: Bladder catheterization (BC) is frequently performed to diagnose urinary tract infection (UTI) (the most common serious bacterial infection among young children). The purposes of this study were to evaluate performance and complications of BC to obtain a urine specimen. MATERIAL AND METHODS: This was a prospective study conducted in an urban children's hospital on patients who had a urine specimen obtained in the emergency department (ED) by BC between November 1, 2009 and December 15, 2009. Epidemiological data and the medical reasons why the BC was performed were reviewed. Finally, to determine the complications we contacted the family by telephone at least one month after the BC. RESULTS: A total of 126 BC were performed in 124 patients, 45 males (35.7%) and 81 female (64.3%). A urine sample was obtained in all cases. The median age was 7 months (5 days-35 months). Of the 126 urine cultures collected, 34 were positive (26.98%) and 1 was considered contaminated (0.8%). Escherichia coli was the most common pathogen (27, 79.41%). Fever (76.2%) was the main reason why BC was performed in children. Of the 116 patients contacted by telephone, only 5 mentioned complications: genital pain (3), unconfirmed hematuria (1) and UTI 12 days after (1). CONCLUSIONS: BC performed in ED to obtain a urine sample in non toilet-trained children is effective and safe. BC is an invasive method which needs to be quality controlled.

[Utility of Boyer's score modified for the differential diagnosis of bacterial and viral meningitis]. / Utilidad del score de Boyer modificado para el diagnóstico diferencial de las meningitis bacterianas y víricas.

BACKGROUND: Many studies have been performed to establish criteria for the differential diagnosis between bacterial and viral meningitis. In 1980, Thome and Boyer proposed a score that has been widely used. OBJECTIVES: The aim of this study was to assess the utility of this score when applied to our patients with meningitis and to evaluate the diagnostic yield after adding other laboratory tests. METHODS: We retrospectively studied the children diagnosed with meningitis in the Hospital Niño Jesús between January 1993 and February 2000. In all patients, Boyer's score and the following laboratory variables were applied: reactive C protein levels, percentage of neutrophils in the cerebrospinal fluid depending on age, and the ratio of immature cells/total neutrophils in the blood. We calculated the sensitivity and specificity of Boyer's score and the laboratory variables. RESULTS: Of the 476 children with meningitis, 402 had viral meningitis and 74 had bacterial meningitis. All the children with bacterial meningitis except seven had a score higher than 3 (a doubtful indication for antibiotic treatment). The sensitivity and specificity of Boyer's score was 90 % and 99 % respectively. When laboratory variables were added, sensitivity was 100 % and specificity was 98 %. CONCLUSIONS: Boyer's score is a useful tool for the differential diagnosis of meningitis, but its diagnostic yield is considerably increased when the results of laboratory tests are added.

[Complications of varicella in children]. / Complicaciones de la varicela en niños.

OBJECTIVE: The purpose of this study was to describe varicella complications that result in the hospitalization of children in our hospital, as well as the associated cost. PATIENTS AND METHODS: A retrospective study involving 84 children hospitalized for complications due to varicella between January 1993 and December 1997 was carried out. Oncology patients were excluded. Data about age, sex, previous health conditions, complications developed, days of admission and treatments, amongst others, was collected and descriptive statistics performed. We also estimated the costs of hospitalization. RESULTS: We identified 84 children hospitalized for complications of varicella, which represents 2.67% of the total cases of varicella attended in the Emergency Room (3,135). Of these children, 72.6% were healthy before the onset of varicella. The mean age was 3.3 +/- 2.6 years. Skin or soft tissue infections were the most common complication, with all of the cases occurring in children under 5 years of age. Central nervous system complications were found in 19.27%, with involvement of the cerebellum accounting for the majority of the cases of encephalitis. Bilateral facial palsy was observed in one patient. Respiratory complications (14.45%) included pneumonia, bronchitis and croup. Other types of complications, such as gastrointestinal (9.63%), musculo-skeletal (4.76%) and hematological were less frequent. The mean hospital stay was 7.7 +/- 4.8 days. The cost associated with the admission of these children was 43,681,528 pesetas. CONCLUSIONS: Varicella complications represent an important morbidity for a disease that has long been considered benign and inevitable in children. The implementation of a varicella vaccine program for healthy children would be beneficial for the prevention of complications and the reduction in their associated cost to the health care system.

[Pediatric primary care seen through a hospital emergency service]. / La asistencia primaria pediátrica vista a través de un servicio de urgencias hospitalario.

We have studied the procedures for taking care of the 1,044 patients who arrived in the Emergency Room at the Niño Jesus Hospital on weekday mornings, in order to evaluate the operation of primary pediatric care as the possible generator of the demand for emergency hospital care. We also took into account the motivations which the parents of the children gave for not having gone to their doctors. The diagnosis and/or prior treatment were considered adequate in 83.81% of cases, and in 64.63% of cases in which these were known for a fact. 35.7% of the children were periodically checked out by their doctors even though they were not ill. Among the motives given by the parents for going directly to the Emergency Room, only 5.69% and 8.41% respectively said that it was due to an emergency situation or a worsening of the patient's state. 35.89% pointed out that their pediatricians had afternoon hours, and 20.91% that they went to the Emergency Room systematically regardless of the problem. Only 10.27% said that they were unhappy with their doctor. From our data it would seem that the demand for emergency pediatric hospital care is due more to a lack of health education of the population than to deficiencies in primary care.