[The concept of damage control in pediatrics: everything a physician needs to know in practice]. / Le concept de « damage control ¼ en pédiatrie : tout ce qu'un médecin doit savoir en pratique.

The concept of damage control in pediatrics: everything a physician needs to know in practice. After the terrorist attacks in France and the rest of the world, children may be potential targets and be part of the victims. In order to prepare for these situations of «war medicine¼ our medical training is inadequate. It seems important to draw attention to the care strategy to adopt in these exceptional situations: the concept of «damage control resuscitation¼ from military experience in conflict zones aims to reduce preventable deaths, using simple and quick gestures. In practice, the goal is to control bleeding sites and to fight against the lethal triad of hypothermia, acidosis and coagulopathy to bring the patient to a minimalist rescue surgery in one hour. The success of this overall strategy depends on effective communication and coordination between pre-hospital teams on site and hospital teams with the sole objective: patient survival by prioritizing medical care and evacuations. Although the experience of damage control is limited in pediatrics, its principles can be applied to the child taking into account the particularities of its own physiology. It seems essential today for every physician, single witness or real frontline actor, to be familiar with these first aid techniques that could save children's lives.

Le concept de « damage control ¼ en pédiatrie : tout ce qu'un médecin doit savoir en pratique. Au vu des attentats terroristes qui ont frappé la France, les enfants peuvent aussi constituer des cibles potentielles et figurer au nombre des victimes. Devant ces situations apparentées à de la « médecine de guerre ¼ face auxquelles nos formations de médecin ne nous ont pas préparés, il nous semble important d'attirer l'attention sur la stratégie à adopter pour la prise en charge des enfants. Le concept de « damage control ¼ issu de l'expérience militaire en zones de conflits a pour objectif de limiter les décès évitables en utilisant des gestes simples et rapides. En pratique, il s'agit de contrôler les sites hémorragiques et de lutter contre la triade létale : hypothermie, acidose, coagulopathie, pour amener le patient à une chirurgie minimaliste de sauvetage dans l'heure. La réussite de cette stratégie globale est conditionnée par une communication et une coordination efficaces entre les équipes préhospitalières sur place et les équipes hospitalières, avec pour seul objectif la survie des patients, en priorisant soins et évacuation. Même si l'expérience du « damage control ¼ est limitée en pédiatrie, ses grands principes peuvent être appliqués à l'enfant en tenant compte des particularités liées à sa physiologie propre. Il semble indispensable aujourd'hui que chaque médecin, simple témoin ou véritable acteur de première ligne, connaissent les gestes de sauvetage des premières minutes susceptibles de sauver la vie d'enfants.

Impact of rapid influenza diagnostic test on physician estimation of viral infection probability in paediatric emergency department during epidemic period.

BACKGROUND: The clinical diagnosis of influenza is difficult in the younger children. OBJECTIVES: Evaluate the impact of rapid influenza diagnostic test (RIDT) on clinicians' estimation of the clinical probability of influenza in children. STUDY DESIGN: This prospective study included children aged from 1 month to 5 years who were admitted in a university paediatric emergency department during an influenza epidemic period and presented with fever without source. The RIDT Quickvue(®) was performed on nasopharyngeal aspiration and results were confirmed with immunofluorescence and/or PCR. The clinical probability of influenza and serious bacterial infection (SBI) was evaluated for each child before and after the physician(s) was informed of the RIDT results. RESULTS: 170 children were included from January 15th through March 18th, 2013. After the only clinical examination, the overall clinical probability of influenza was 66.0% [CI 95%: 63.04-68.4], and was significantly increased at 92.4% [CI 95%: 89.5-95.3] in case of positive RIDT and significantly decreased at 30.8% [CI 95%: 29.0-32.5] in case of negative RIDT without knowing the results of laboratory tests. Whereas the initial clinical probability of influenza were appropriate regarding the prevalence (66.0% vs. 57.0%), the probability of SBI was overestimated (30.2% vs. 8.8%). The RIDT result positive enabled a significant decrease in orders for chest X-rays (64,4% vs. 45.8%, p<0,05) and laboratory tests (71,1% vs. 41.1%, p<0,05). CONCLUSIONS: The RIDT seems to be a useful diagnostic tool for ED clinicians in epidemic conditions. Improving clinician estimation of flu probability would reduce orders for imaging and testing.