Spanish primary care in pediatric trauma (AITP) consensus: An AITP checklist. / Consenso AITP español: Una lista de verificación AITP.

INTRODUCTION: The course in Primary Care in Pediatric Trauma (ATIP in Spanish) has been taught in Spain since 1997, and there are currently 9 accredited training centers. Care of polytraumatized pediatric patients often takes place in an environment conducive to errors resulting from forgetfulness, which is why checklists - mnemonic tools widely used in industry and medicine - are particularly useful to avoid such errors. Although several checklists exist for pediatric trauma care, none have been developed within the setting of our course. MATERIALS AND METHODS: The criteria for being selected as an expert in Primary Care in Pediatric Trauma were agreed upon with the scientific polytrauma committee of the Spanish Pediatric Surgery Society. The items that make up the checklist were obtained from a review of the literature and consultation with selected experts, using the Delphi Technique. RESULTS: 10 experts representing the 9 groups or training centers in Primary Care in Pediatric Trauma were selected, and a 28-item checklist was drawn up in accordance with their design recommendations. CONCLUSIONS: With the consensus of all the groups, a checklist for the treatment of polytraumatized pediatric patients was drawn up using the Delphi Technique, an essential requirement for the dissemination of this checklist, which should be adapted and validated for use in each healthcare center.

INTRODUCCION: El curso de Asistencia Inicial al Trauma Pediátrico se imparte en España desde 1997, existiendo en la actualidad 9 centros formadores acreditados. La asistencia al paciente pediátrico politraumatizado se produce muchas veces en un ambiente proclive al error por olvido, por lo que las listas de verificación, como herramientas mnemotécnicas de amplia difusión en la industria y en medicina, serían especialmente útiles para evitarlos. Aunque existen varias listas de verificación para la asistencia al traumatismo pediátrico, ninguna se ha desarrollado en el entorno de nuestro curso. MATERIAL Y METODOS: Se acordaron los criterios para ser seleccionado como experto en Asistencia Inicial al Trauma Pediátrico con la comisión científica de politrauma de la Sociedad Española de Cirugía Pediátrica. Los ítems para formar la lista de verificación se obtuvieron a partir de una revisión bibliográfica y de la consulta a los expertos seleccionados, empleando un método Delphi. RESULTADOS: Se seleccionaron 10 expertos que representan los 9 grupos o centros formadores en Asistencia Inicial al Trauma Pediátrico y se elaboró una lista de verificación con 28 ítems, siguiendo sus recomendaciones de diseño. CONCLUSIONES: Se diseñó una lista de verificación para el manejo del paciente pediátrico politraumatizado, con el consenso de todos los grupos empleando un método Delphi, requisito fundamental para facilitar la difusión de esta lista. Sería preciso adaptar y validar dicha lista para su uso en cada centro asistencial.

[Is there appendiceal stump appendicitis?] / ¿Existe la apendicitis del muñón apendicular?

INTRODUCTION: Stump appendicitis is the remaining appendicular tissue inflammation after a variable length of time. It is a very infrequent pathology with a paucity in pediatric publications, and given the fact that a delay in its diagnosis could lead to an increased morbidity, this is the reason of its clinical relevance. CLINICAL CASE: A 10 years old girl who had laparoscopic excision of a flemonous-gangrenous appendicitis and who 45 days after surgery showed new clinical symptoms compatible with a diagnosis of acute appendicitis. Abdominal ultrasound and CAT scans were suggestive of stump appendicitis. On a second laparoscopic operation, the rest of the stump was removed with full recovery and without complications. COMMENTS: What is interesting about this case is to describe this rarely seen pathology, specially in paediatrics, as well as the treatment and the prevention of such complication highlighting the importance of the correct identification of the appendicular base o caecum-appendicular union in the initial surgery.

INTRODUCCION: La apendicitis del muñón es la inflamación del tejido apendicular remanente tras la apendicectomía después de un periodo de tiempo variable. Es una patología de muy rara aparición con escasez de casos publicados en niños, de ahí su relevancia clínica, en la cuál el retraso en el diagnóstico puede conllevar una morbilidad elevada. CASO CLINICO: Niña de 10 años de edad intervenida de apendicitis flemono-gangrenosa por vía laparoscópica que, a los 45 días de la intervención presenta un nuevo cuadro clínico compatible con apendicitis aguda. Se practica ecografía y TAC abdominal que confirman la sospecha diagnóstica de apendicitis del muñón. Se interviene nuevamente por vía laparoscópica y se reseca el resto del muñón apendicular, con una evolución posterior favorable y sin nuevas complicaciones. COMENTARIOS: El interés de este caso es presentar esta patología tan poco frecuente, especialmente en pediatría, así como el tratamiento y la forma de prevenir dicha complicación recalcando la importancia de la correcta identificación de la base apendicular o unión ceco-apendicular en la cirugía inicial de la apendicitis.

[One-step low profile percutaneous endoscopic gastrostomy: our experience in children]. / Gastrostomía percutánea endoscópica con colocación de botón en un solo tiempo: nuestra experiencia en niños.

OBJECTIVES: Percutaneous endoscopic gastrostomy (thu) is the preferred method for the placement of a gastrostomy in children. In recent years a system to perform a button gastrostomy in one step has been designed (PEG-B). This system offers advantages over classical PEG although the potential risk of complications is greater. The aim of this paper is to present our experience with PEG-B. METHODS: . Retrospective review of pediatric patients who have received the PEG-B system during 2013 in Hospital Universitario Son Espases, Pamna de Mallorca. Parameters analyzed included demographics, indications, feeding start, length of hospital stay and complications. RESULTS: . A total of 8 patients, aged 8 months to 14 years, were included in the study. Indications were neurologic disease in 4 patients, metabolic disorders in 3 and tumors in 1. The weight range was 5.5 to 36 kg with a median of 12.4 kg. 16 Fr buttons were placed with length adjusted to each patient. The use of the gastrostomy started between 4-48 hours. The average length of hospital stay was 43.5 hours (24h-72h). There have been no major complications in 6 months follow up. A single pneumoperitoneum occurred postoperatively and two granulomas, one of them at one of the anchor points of the gastrostomy. CONCLUSIONS: Although it is a small series, no major complications were found and results are comparable to results published in the surgical literature in both techniques. We believe that the PEG-B is a good choice for PEG placement in children.

[Multicystic Kidney: is there any new scientific evidence to recommend nephrectomy?]. / Riñón multiquístico: existe alguna nueva evidencia científica que recomienda la nefrectomía?

With the aim to create a scientific evidence of the convenience or not of removing the Multicystic Kidney (MK), a systematic review has been done over the last 20 years, selecting those articles with determinant criterions. Our experience has been also evaluated. We have obtained an evidence table of 1082 MK, with a follow-up from 2 to 7 years. No case degenerated. The complications were: urinary tract infection (UTI) in 5% and hipertensión (HTA) in 0.7%. In our serie (68 cases): nephrectomy was done in 10 cases. 82% completely involved (66.6% before 5 years and 15.6% from 5 to 15 years of follow-up). 18% involved partially. No case degenerated. The complications were UTI (6 cases) and HTA in one. Periodical ultrasound follow-up is our recommendation for MK due to the results of our serie and from the systematic review of the literature.