[Minor head trauma in children: clinical surveillance or systematic computerized tomography?]. / Traumatismes crâniens dits bénins de l'enfant: surveillance clinique ou tomodensitométrie cérébrale systématique?

In children, minor head trauma is a common injury that can result in intra cranial injury. The 6th "Conférence de consensus en réanimation et médecine d'urgence" in 1990, then the American Academy of Pediatrics in 1999, published clear guidelines for management of head injured children older than 2 years, specially regarding X-ray imaging, while currently no clear guidelines exist regarding children younger than 2 years. Being at higher risk for injuries and more difficult to assess, many authors recommend for these young children a low threshold for X-ray imaging. However we believe that many asymptomatic infants older than 3 months of age who have no significant scalp hematoma, no high force mechanism of injury, and no suspicion of child abuse, can be safely managed without X-ray imaging.

[Predicting the use of Emla cream by the triage nurse in a paediatric emergency department]. / Prédiction de l'utilisation de la crème Emla par l'infirmière d'accueil dans un service d'urgences pédiatriques.

INTRODUCTION: The current issue of paediatric emergency care is to decrease the length of stay of the child and his/her family in the emergency department while improving health care quality. Up to now, the paediatric emergency department's triage nurses of the children's Timone hospital apply two EMLA patches when they think that a blood test will be ordered by the medical doctor in order to decrease the waiting time between the clinical exam and the blood test. PURPOSE: The objective of this study was to check if this attitude allowed to efficiently select children who will actually get a blood test. MATERIAL AND METHODS: During four weeks, the triage nurses were asked to write down for each patient after the reception time whether or not a blood test would be ordered by the medical doctor after clinical exam. We compared these data to the number of blood tests actually done. RESULTS: Out of the 2758 children admitted in the emergency department during this period, 1973 nurse prediction forms were filled out. The triage nurses predicted a blood test for 253 patients. Out of these 253 patients, only 132 of them had a blood test done. The study of various studied criteria did not allow to reveal any good agreement between the nurse and the medical doctor. CONCLUSION: The literature study shows that some medical criteria allow to improve this agreement rate. The assessment of blood test necessity have to be carried on and needs further studies in order to precise the most discriminant medical criteria.

[Use of polydimethylsiloxane in the endoscopic treatment of urinary incontinence of neurologic origin in children]. / Utilisation du polydiméthylsiloxane dans le traitement endoscopique de l'incontinence urinaire d'origine neurologique chez l'enfant.

AIM: We report the use of polydimethylsiloxane (PDS-Macroplastique) in endoscopic treatment of urinary incontinence in children with neurogenic bladder and try to determine optimal criteria for patient selection. METHODS: Forty four children (19 males, 25 females) have been treated since 1995. Aetiology was mainly spina bifida (n = 36). Previous surgery had been performed in 26 patients, including bladder neck reconstruction in 21 cases and bladder augmentation in 15 cases. Mean age at injection was 13 years (7 to 17). Only one injection was performed in 27 patients, two injections in 4 cases, and three and more injections in 3 cases. Mean volume at each injection was 3.6 cc. Mean interval between two injections was 6 months (3-15 m). All injections were performed transurethrally. RESULTS: Follow-up ranged from 6 to 41 months (median: 23). Fifteen patients (34%) are dry (continence > 4 hours, no urinary pad during the day) and 11 (25%) are improved (continence from 2 to 3 hours, minimal pad). Eighteen patients obtained poor results. In the entire series previous bladder neck surgery or preoperative detrusor hyperactivity did not interfere with the results. The only difference concerns the sex-ratio: the good results were mainly seen in females: 44% of girls are cured versus 21% of boys. CONCLUSION: Injection of PDS in the bladder neck achieve the goal of continence in 34% of the cases in neurogenic bladder. Better results are seen in girls. Injection does not compromise other surgical procedures. The use of PDS seems more suitable than bovine collagen in view of the potential problems of prions.

[Pediatric surgical emergencies]. / Urgences chirurgicales pédiatriques.

A quarter of pediatric surgical emergencies are non trauma and are for most of them limping child, acute abdominal pain, and acute scrotum. All of the child's lower limb pathology can be described as a limp, and the same is true for abdominal pain and acute scrotum. We will describe the important inquiring and clinical tools as well as a few simple paraclinics that allow to recognize the few cases requiring emergency care.