Do not do recommendations in different paediatric care settings.

INTRODUCTION: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics (AEP) has proposed the development of "DO NOT DO" recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. MATERIAL AND METHODS: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. RESULTS: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the AEP and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. CONCLUSIONS: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice.

[Acute sexual abuse in children and adolescents: a methodological contribution to improve the quality of care.] / Abuso sexual infanto-juvenil agudo: una aportación metodológica para mejorar la calidad asistencial.

OBJECTIVE: The complexity of consultations for child and adolescent sexual abuse (CSA), added to the high service pressure in Emergency Department (ED), makes legal proceedings to be prioritized over medical action, and security incidents may appear. Our objective was to evaluate the impact of a checklist for the management of acute CSA in ED, assessing the number and type of security incidents. METHODS: A single-centre, descriptive-observational study was conducted between 2018 in ED. Clinical, epidemiological and follow-up data were collected in those patients younger than 18 that were reported as acute CSA suspicions. Incidents about clinical history, procedures and medication were analyzed. The sample were divided in two groups in relation the use of checklist (Group1: January-May and Group 2: June-December). RESULTS: Thirty-two patients were included: 13 Group 1, 19 Group 2. In 25 (78.1%) incidents were detected from the clinical history, in 20 (56.3%) from procedures and in 5 (15.5%) from medication. One-hundred by one-hundred clinical history incidents and 100% procedural incidents were observed in Group 1 vs 63.2% and 36.8% in Group 2 (p=0.025 y p=0.007) and 30.8% of medication incidents in Group 1 vs 5.3% in Group 2 (p=0.051). CONCLUSIONS: The implementation of the checklist has led to an improvement in the medical care of patients with acute CSA with a decrease in security incident.

OBJETIVO: La complejidad de las consultas por abuso sexual infantojuvenil (ASI) sumada a la presión asistencial en el servicio de urgencias (SU) hace que se prioricen las diligencias legales a la actuación médica pudiendo aparecer incidentes de seguridad. El objetivo de este trabajo fue evaluar el impacto de un checklist para el manejo de ASI en el SU valorando el número y tipo de incidentes de seguridad. METODOS: Estudio unicéntrico, descriptivo-observacional. Se recogieron datos clínicos, epidemiológicos y de seguimiento de todos los pacientes menores de 18 años que fueron atendidos en el SU por sospecha de ASI agudo durante 2018. Se analizaron los incidentes de la historia clínica, procedimientos y medicación. La muestra se dividió en dos grupos en relación al inicio del uso del checklist en el SU (Grupo: Enero-mayo y Grupo 2: junio-diciembre). RESULTADOS: Se incluyeron 32 casos: 13 Grupo 1, 19 Grupo 2. En 25 (78,1%) se detectaron incidentes de historia clínica, en 20 (56,3%) de procedimiento y en 5 (15,5%) de medicación. Se observaron 100% de incidentes tanto de historia clínica como de procedimiento en el Grupo 1 vs 63,2% y 36,8% respectivamente en el Grupo 2 (p=0,025 y p=0,007) y 30,8% de medicación en Grupo 1 vs 5,3% en Grupo 2 (p=0,051). CONCLUSIONES: La implantación del checklist ha supuesto una mejora en la atención médica de los pacientes con ASI agudo, con una disminución de los incidentes de seguridad.

[Comparative analysis of the incidence of alcohol intoxication in adolescents in a pediatric emergency department.] / Análisis comparativo de la incidencia de intoxicaciones etílicas en adolescentes en un servicio de Urgencias pediátricas.

OBJECTIVE: A retrospective study (2007-2012) of acute alcohol intoxication (AAI) in the paediatric Emergency Department (ED) (Hospital Sant Joan de Déu, Barcelona) demonstrated a decrease in the rates of AAI over the last two years. Aim: to determine if this decile continued during the following 5 years and to describe the profile and clinical management of these patients. METHODS: Descriptive, retrospective and observation study. Adolescents who presented to the ED (Hospital Sant Joan de Déu, Barcelona) with AAI were included (2007-2017). Patients were classified in two groups: mil and moderate/severe; we compared the differences in the clinical management (monitoring of vital signs, lab test and treatment). We defined the AAI incidence rate: number of AAI every 1000 ED adolescent consultations/year. RESULTS: We included 836 AII, incidence rate: 7.7;2007, 8.5;2008, 6.6;2009, 7.8;2010, 6.4;2011, 6.4;2012, 4.8;2013, 4.6;2014, 5.5;2015, 4.8;2016 and 3.4;2017. The mean age was 15.9 (SD 1.2) years, 54.9% (459) were women. 54.5% had mild AAI, 45.4% moderate/severe. The temperature was taken to 607 patients, capillary blood glucose to 573 and blood pressure to 633. We found no differences in the monitoring of vital signs regardless of the symptoms of the patients. Patients with moderate/severe AAI underwent blood test more frequently than those with mild AAI (ethanol levels 88.2% vs 50.4%; p<0.001; electrolytes 81.2% vs 48%, p<0.001; glucose levels 64.4% vs 37.1%, p<0.001). Four hundred and twelve patients (49.3%) received fluid therapy. Twenty-two patients were admitted. CONCLUSIONS: The incidence of AAI decreased over the last years. The profile of these patients remains unchanged (adolescents with moderate AAI during weekends). Even though lab test were performed more frequently to patients with moderate/severe AAI, clinical management should be improved by taking vital signs and capillary glycemia to all patients, keeping the blood analysis for moderate-severe AAI.

OBJETIVO: Una revisión retrospectiva (período 2007-2012) de las intoxicaciones etílicas agudas (IEA) en el Servicio de Urgencias Pediátrico (SUP) del Hospital San Joan de Déu, de Barcelona, evidenció un descenso de las visitas por IEA los últimos dos años. El objetivo de este trabajo fue comprobar si este descenso se había mantenido los 5 años posteriores, así como describir el perfil y manejo de estos pacientes. METODOS: Se realizó un estudio descriptivo, retrospectivo y observacional. Se incluyeron consultas de adolescentes en el SUP del Hospital San Joan de Déu, de Barcelona, por IEA (período 2007-2017). Se dividieron los pacientes en IEA leve y moderada-grave. Se valoraron las diferencias en su manejo (toma de constantes, analítica y tratamiento.) Se definió la tasa de incidencia de IEA cada 1.000 visitas a Urgencias de adolescentes/año. RESULTADOS: Se incluyeron 836 IEA. Las tasas de incidencia por años fueron: 7,7% (2007); 8,5% (2008); 6,6% (2009); 7,8% (2010); 6,4% (2011); 6,4% (2012); 4,8% (2013); 4,6% (2014); 5,5% (2015); 4,8% (2016) y 3,4% (2017). La edad media fue de 15,9 (DE 1,2) años, siendo mujeres el 54,9%. Presentó IEA leve un 54,5% y moderada-grave un 45,4%. Se determinó temperatura a 607, glicemia capilar a 573 y tensión arterial a 633. No hubo diferencias significativas en la determinación de las tres constantes según la clínica de intoxicación. A los pacientes con IEA moderada-grave se les realizó analítica sanguínea con mayor frecuencia que a los de IEA leve (niveles de etanol del 88,2% frente al 50,4%; p<0,001 / EAB-ionograma del 81,2% contra el 48%, p<0,001 / glicemia venosa del 64,4% respecto al 37,1%, p<0,001). Se administró sueroterapia a 412 (49,3%). Precisaron ingreso 22 pacientes. CONCLUSIONES: La incidencia de IEA en SUP disminuye. Se mantiene el perfil de adolescentes (IEA moderadas el fin de semana). Aunque se realizó analítica con mayor frecuencia a los pacientes con IEA moderada, el manejo de las IAE presenta aspectos mejorables, debiendo preconizar la toma de constantes y la glicemia capilar en todos los pacientes, reservando la analítica para los pacientes moderados-graves.

Invasive disease by Streptococcus pyogenes: patients hospitalized for 6 years. / Enfermedad invasiva por Streptococcus pyogenes: ingresos durante 6 años.

INTRODUCTION AND OBJECTIVE: The last years an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyze the epidemiology and the clinical features of ID due to SGA in a tertiary Pediatric Hospital. MATERIAL AND METHODS: Retrospective study in a Pediatric hospital, of all in-patients with final diagnosis of ID due to SGA during 6 years (2009-2014). To consider ID, SGA had to be isolated in sterile samples; in patients with fascitis necroticans in skin samples or in any sample in patients with the diagnostic of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of these criteria: renal failure, hepatic failure, acute respiratory distress, tissue necrosis or desquamative erythematous rash. Demographic data, type of infection, risk factors, clinical presentation, analytical data at admission, treatment, need for admission to a pediatric intensive care unit, microbiological data, hospital stay and evolution were collected. RESULTS: Fifty-two (52) cases were included (12/10,000 of all inpatients); 3 years-old was the medium age (p25-75: 1.4-6.9 years); 28 (53.8%) were boys. Fourteen patients (26.9%) had risk factors. Fever was the major symptom (51 patients, 98.1%). The skin lesions were the most frequent clinical manifestations found (21; 40.4%). In 50 (96%) cases, SGA was isolated in at least one sterile sample. Skin and soft tissue infections were diagnosed in 14 patients (26.9%), 14 (26.9%) pneumonias, 12 (23.1%) bones and joints infections, 10 (19.2%) SSTS, 6 (11.5%) occult bacteremia, 4 (7.7%) meningitis and 2 (3.8%) sepsis. Surgery was required in 18 cases (34.6%) and 17 patients (32.7%) needed intensive care. The medium hospital stay was 9.5 days (p25-75: 8-15 days). Three patients presented sequels and one patient died. CONCLUSION: The ID due to SGA was a rare but serious reason for hospital admission. Skin and soft tissue infections, and pleuroneumonia were the most common forms of ID. The mortality of our sample was low despite the serious clinical manifestations.

[Epidemiology and risk factors in injuries due to fall in infants under one year-old]. / Epidemiología y factores de riesgo de las lesiones por caídas en niños menores de un año.

OBJECTIVES: To describe the epidemiological characteristics of unintentional injuries due to falls in children under one year and to analyse the risk factors associated with severe injuries. PATIENTS AND METHODS: This multicentre, observational and cross-sectional study included all children less than one year treated for unintentional fall in the Emergency Departments of 8 Spanish Hospitals, belonging to the «Unintentional Paediatric Injury Workshop¼ of the Spanish Paediatric Emergency Society, between March 1st, 2014 and February 28th, 2015. RESULTS: Out of 289,887 emergency department cases, 1,022 were due to unintentional falls. The median age was 8 months and 52.5% were males. Fall injuries were more frequent among children aged 9-12 months (37.6%), and 83.5% occurred at home. The most common mechanism was fall from nursery equipment (69.4%), and 47.8% occurred from a height under 50cm. More than two-thirds (68%) of falls were witnessed, but in half of the cases (329) the caregiver was not in area. Serious injuries were seen in 12% of cases. In this study, a fall height greater than 50cm, falls in the street, from the arms of the carer, and from the stairs were identified as independent risk factors for worse outcomes. CONCLUSIONS: The most serious injuries occur in children <3 months and from a height of >50cm, though not related to unwitnessed falls. Because the most common serious injury mechanism is the fall from the arms of the carer, from stairs, and falls in the street, these facts should be highlighted in order to avoid morbidity.

[Psychoactive drugs use and related visits of adolescents to the emergency department]. / Implicación de las sustancias psicoactivas en las consultas de adolescentes en urgencias.

BACKGROUND AND OBJECTIVES: To describe psychoactive substances (PS)-related visits of adolescents to the emergency department and to explore possible differential features in patients according to the kind of PS consumed. PATIENTS AND METHODS: Observational and analytic study. PS-related visits of adolescents to the emergency department during 30 months were studied. Patients were divided in two groups: those with alcohol intoxication only (Group_1) and those with other PS (Group_2) and they were compared. RESULTS: 333 consults were included, corresponding to 321 patients. Their mean age was 16,1 years (SD:1,1 years). Two hundred sixty-two(78,7%) were alcohol-related visits, and 110(33%) were related with another PS consumption. Of the 262 alcohol-related visits, 223 were only related with alcohol(Group_1), while the other 110 visits made up Group_2. Group_2 was composed of more males, more adolescents placed in Institutional Care and more adolescents with psychiatric records than Group_1. Likewise, distribution of Group_2 visits was less predictable than distribution of Group_1. CONCLUSIONS: PS consumption is a frequent major complaint in an Emergency Department. There are more poly-intoxications in males with psycho-social problems. In those cases, consumption seems to happen regardless of the time in the day or the day of the week.