Family presence during invasive procedures at the emergency department: what is the opinion of Spanish medical staff?

OBJECTIVES: Family presence (FP) during invasive procedures (IPs) in children remains controversial among pediatric emergency department (PED) staff. The authors aimed to determine health care providers' attitudes toward FP during IPs in Spain, to learn whether parents are given the option of being present during different IPs, and to study which factors influence the providers' opinions. METHODS: Observational study. Physicians and nurses were asked to answer a questionnaire, which was sent to 43 PEDs and was available at the Spanish Pediatric Emergency Society Web site. RESULTS: We obtained 222 questionnaires from 36 Spanish hospitals. A total of 65.8% of the surveys were answered by physicians (66.4% pediatricians) and 34.2% by nurses. The median age of the respondents was 32 years, and 69.2% were women. Parents were given the option of being present during blood sampling (36.4%), intravenous line placement (32.7%), urethral catheterization (32.1%), lumbar puncture (13.5%), and resuscitation (1%). More than 60% of providers approved of FP during blood sampling, sutures, intravenous line placement, and urethral catheterization; however, only 10.8% of providers encourages FP during resuscitation. Against FP, health care staff argue procedural invasiveness (75.6%), parents' anxiety (87.6%), and worsened performance of the procedure (66%). Commonly expressed advantages were reducing patient distress (72.9%) and parent anxiety (62.3%). Physicians, especially the older ones, are more likely to encourage FP than nurses for some IPs. CONCLUSIONS: The PED staff tend to prefer parents not to be present during IPs as the level of invasiveness increases. Family presence is not common in Spanish PEDs. Older physicians are more likely to support FP than nurses.

Caregiver willingness to vaccinate their children against COVID-19: Cross sectional survey.

BACKGROUND: More than 100 COVID-19 vaccine candidates are in development since the SARS-CoV-2 genetic sequence was published in January 2020. The uptake of a COVID-19 vaccine among children will be instrumental in limiting the spread of the disease as herd immunity may require vaccine coverage of up to 80% of the population. Prior history of pandemic vaccine coverage was as low as 40% among children in the United States during the 2009 H1N1 influenza pandemic. PURPOSE: To investigate predictors associated with global caregivers' intent to vaccinate their children against COVID-19, when the vaccine becomes available. METHOD: An international cross sectional survey of 1541 caregivers arriving with their children to 16 pediatric Emergency Departments (ED) across six countries from March 26 to May 31, 2020. RESULTS: 65% (n = 1005) of caregivers reported that they intend to vaccinate their child against COVID-19, once a vaccine is available. A univariate and subsequent multivariate analysis found that increased intended uptake was associated with children that were older, children with no chronic illness, when fathers completed the survey, children up-to-date on their vaccination schedule, recent history of vaccination against influenza, and caregivers concerned their child had COVID-19 at the time of survey completion in the ED. The most common reason reported by caregivers intending to vaccinate was to protect their child (62%), and the most common reason reported by caregivers refusing vaccination was the vaccine's novelty (52%). CONCLUSIONS: The majority of caregivers intend to vaccinate their children against COVID-19, though uptake will likely be associated with specific factors such as child and caregiver demographics and vaccination history. Public health strategies need to address barriers to uptake by providing evidence about an upcoming COVID-19 vaccine's safety and efficacy, highlighting the risks and consequences of infection in children, and educating caregivers on the role of vaccination.

[Profile of the child seen in the resuscitation room]. / Perfil del niño atendido en la sala de críticos de Urgencias.

OBJECTIVE: The attention provided to the seriously ill represents a great challenge for health care professionals; familiarity with this profile will allow for the optimal use of resources and will also lead to an improvement in the training of the health professionals. We sought to understand the characteristics of patients seen in the resuscitation room (RR) of a pediatric emergency department (PED), and to determine the risk factors for a poor evolution. METHODS: An observational analytical study was carried out in the PED of a third-level pediatric hospital from September 2016 through August 2017. Included were those patients attended to in the RR; we analyzed their demographic variables, where they were from, how they arrived at the hospital, their reasons for seeking care (medical vs accident), procedures applied, treatments given, diagnoses, and discharge destination. We used logistic regression analysis to determine the independent risk factors for poor evolution. RESULTS: Included were 114 patients. Their median age was 9.9 years (p25-75=4.0-14.7); 65.8% were male. The patients arrived from the street (51.8%) and from home (31.6%); more than two thirds arrived by ambulance (69.3%). Some 42.1% presented with an unstable pediatric assessment triangle (PAT). Some 64.9% were seen for polytrauma (87.8% with stable PAT). Procedures were carried out on 79.8% of the patients. The most frequent diagnoses were polytrauma (64.9%) and convulsive status (14%). The discharge destinations were: home (28.1%), hospital ward (35.1%), intensive care unit (30.7%), and surgery (4.4%); two patients died in the RR. With the univariate study, we identified risk factors for poor outcome: internal medical condition (52.5% vs 21.6%, p=0.001) and age <2 years (55.6% vs 28.1%, p=0.023). In the multivariate study, the medical cause was maintained as an independent risk factor (OR 4 (CI 95% 1.7-9.2), p=0.001). CONCLUSIONS: The profile of the patient seen in the RR is of a school-age child in stable condition, arriving by ambulance for polytrauma. The children seen for internal medical reasons had poorer outcomes.

OBJETIVO: La atención sanitaria a los pacientes gravemente enfermos constituye un reto sanitario; es importante conocer el perfil de estos pacientes, para optimizar los recursos y mejorar la formación de los profesionales. El objetivo del estudio fue conocer las características de los pacientes atendidos en la Sala de Críticos (SC) de un Servicio de Urgencias Pediátricas (SUP) y determinar los factores de riesgo de mala evolución. METODOS: Se realizó un estudio analítico observacional en el SUP de un hospital pediátrico terciario, entre septiembre de 2016 y agosto de 2017. Se incluyeron los pacientes atendidos en la SC, analizando variables demográficas, procedencia, medio de traslado, motivo de consulta (médica o traumática), procedimientos, tratamientos, diagnóstico y destino. Mediante regresión logística se determinaron los factores de riesgo independientes de mala evolución. RESULTADOS: Se incluyeron 114 pacientes. La mediana de edad fue de 9,9 años (p25-75=4,0-14,7), de los que un 65,8% eran varones. Los pacientes llegaban de la vía pública (51,8%) y del domicilio (31,6%), con un 69,3% mediante traslado en ambulancia. El 42,1% presentaba triángulo de evaluación pediátrica (TEP) inestable. El 64,9% fueron atendidos por politraumatismos (87,8% TEP estable). Al 79,8% se les realizó algún procedimiento. Los diagnósticos más frecuentes fueron politraumatismo (64,9%) y "status" convulsivo (14%). El destino de los pacientes fue domicilio (28,1%), planta (35,1%), Unidad de Cuidados Intensivos (30,7%) o quirófano (4,4%). Dos pacientes resultaron éxitus en la SC. En el estudio univariante, se identificaron como factores de riesgo de mala evolución la causa médica (52,5% frente a un 21,6%, p=0,001) y la edad menor a 2 años (55,6% frente a un 28,1%, p=0,023). En el estudio multivariante, la causa médica se mantuvo como factor de riesgo independiente (OR 4 (IC 95% 1,7-9,2), p=0,001). CONCLUSIONES: El perfil del paciente atendido en la SC es un niño estable en edad escolar, que llega en ambulancia y generalmente por politraumatismo. Los niños atendidos por causa médicas tienen mayor riesgo de peor evolución.

Papel del pediatra de urgencias durante la pandemia por SARS-CoV-2 / Role of the pediatric emergency department during SARS-CoV-2 pandemic

No disponible

[Patient experience in emergency departments: What do children and adolescents think?] / Experiencia del paciente en Urgencias: ¿qué opinan los niños y los adolescentes?

INTRODUCTION: Improving patient experience must become a priority in paediatric emergency departments. This experience is often studied by surveying parents, and not children directly. The aim of this study was to assess the patient experience of children attended in a Paediatric Emergency Department (PED). PATIENTS AND METHODS: A prospective descriptive study was conducted using a survey based on the Picker questionnaire on the patient experience. From January to May 2014, children 8-17 years seen in the Paediatric Emergency Department and admitted to the hospital were asked to complete the questionnaires anonymously, within 24hours of admission. RESULTS: A total of 217 patients completed the survey. The responses showed the 19.4% had to wait longer than expected, with 46.2% saying that there was not enough for children of their age group to do while waiting to be seen. As regards care and treatment, 4.6% of participants said staff did not fully explain what they were doing, and 23% said that they were not given enough privacy when being examined. Overall, 99.1% of patients said that they were well treated. CONCLUSIONS: Overall patient experience in the PED was positive. Some aspects have to be improved (activities in the waiting room, and privacy during the examination).

Papel del pediatra de urgencias durante la pandemia por SARS-CoV-2 / Role of the emergency department pediatrician during SARS-CoV-2 pandemic

No disponible

[Impact of a disaster preparedness training program on health staff]. / Impacto de un programa de formación de catástrofes en el personal sanitario.

OBJECTIVES: The aim of this study is to evaluate the effectiveness of a disaster preparedness training program in a Paediatric Emergency Department (PED). METHODS: A quasi-experimental study was conducted using an anonymous questionnaire that was distributed to health care providers of a PED in a tertiary paediatric hospital. The questions concerned the disaster plan (DP), including theoretical and practical aspects. Questionnaires were distributed and completed in January 2014 (period 1) and November 2014 (period 2). The disaster training program includes theoretical and practical sessions. RESULTS: A total of 110 questionnaires were collected in period 1, and 80 in period 2. Almost three-quarters (71.3%) of PED staff attended the theoretical sessions, and 43.8% attended the practical sessions. The application of this training program significantly improved knowledge about the DP, but no improvement was observed in the practical questions. PED staff felt more prepared to face a disaster after the training program (15.5% vs. 41.8%, P<.001). CONCLUSIONS: The training program improved some knowledge about the disaster plan, but it has not improved responses in practical situations, which may be due to the low attendance at practical sessions and the time between the training program and the questionnaires.

Burnout en los pediatras de urgencias / Burnout in paediatric emergency departments

No disponible

Impacto de una guía para la elaboración de un plan de catástrofes externas en los servicios de urgencias pediátricos / Impact of a disaster preparedness guide for the paediatric emergency department

No disponible

Calidad percibida en un servicio de urgencias pediátricas: ¿y la madre qué opina? / Perceived quality in a pediatric emergency department: what does the mother think about?

No disponible

Perfil del niño atendido en la sala de críticos de Urgencias / Profile of the child seen in the resuscitation room

OBJETIVO: La atención sanitaria a los pacientes gravemente enfermos constituye un reto sanitario; es importante conocer el perfil de estos pacientes, para optimizar los recursos y mejorar la formación de los profesionales. El objetivo del estudio fue conocer las características de los pacientes atendidos en la Sala de Críticos (SC) de un Servicio de Urgencias Pediátricas (SUP) y determinar los factores de riesgo de mala evolución. MÉTODOS: Se realizó un estudio analítico observacional en el SUP de un hospital pediátrico terciario, entre septiembre de 2016 y agosto de 2017. Se incluyeron los pacientes atendidos en la SC, analizando variables demográficas, procedencia, medio de traslado, motivo de consulta (médica o traumática), procedimientos, tratamientos, diagnóstico y destino. Mediante regresión logística se determinaron los factores de riesgo independientes de mala evolución. RESULTADOS: Se incluyeron 114 pacientes. La mediana de edad fue de 9,9 años (p25-75=4,0-14,7), de los que un 65,8% eran varones. Los pacientes llegaban de la vía pública (51,8%) y del domicilio (31,6%), con un 69,3% mediante traslado en ambulancia. El 42,1% presentaba triángulo de evaluación pediátrica (TEP) inestable. El 64,9% fueron atendidos por politraumatismos (87,8% TEP estable). Al 79,8% se les realizó algún procedimiento. Los diagnósticos más frecuentes fueron politraumatismo (64,9%) y "status" convulsivo (14%). El destino de los pacientes fue domicilio (28,1%), planta (35,1%), Unidad de Cuidados Intensivos (30,7%) o quirófano (4,4%). Dos pacientes resultaron éxitus en la SC. En el estudio univariante, se identificaron como factores de riesgo de mala evolución la causa médica (52,5% frente a un 21,6%, p = 0,001) y la edad menor a 2 años (55,6% frente a un 28,1%, p = 0,023). En el estudio multivariante, la causa médica se mantuvo como factor de riesgo independiente (OR 4 (IC 95% 1,7-9,2), p = 0,001). CONCLUSIONES: El perfil del paciente atendido en la SC es un niño estable en edad escolar, que llega en ambulancia y generalmente por politraumatismo. Los niños atendidos por causa médicas tienen mayor riesgo de peor evolución

OBJECTIVE: The attention provided to the seriously ill represents a great challenge for health care professionals; familiarity with this profile will allow for the optimal use of resources and will also lead to an improvement in the training of the health professionals. We sought to understand the characteristics of patients seen in the resuscitation room (RR) of a pediatric emergency department (PED), and to determine the risk factors for a poor evolution. METHODS: An observational analytical study was carried out in the PED of a third-level pediatric hospital from September 2016 through August 2017. Included were those patients attended to in the RR; we analyzed their demographic variables, where they were from, how they arrived at the hospital, their reasons for seeking care (medical vs accident), procedures applied, treatments given, diagnoses, and discharge destination. We used logistic regression analysis to determine the independent risk factors for poor evolution. RESULTS: Included were 114 patients. Their median age was 9.9 years (p25-75=4.0-14.7); 65.8% were male. The patients arrived from the street (51.8%) and from home (31.6%); more than two thirds arrived by ambulance (69.3%). Some 42.1% presented with an unstable pediatric assessment triangle (PAT). Some 64.9% were seen for polytrauma (87.8% with stable PAT). Procedures were carried out on 79.8% of the patients. The most frequent diagnoses were polytrauma (64.9%) and convulsive status (14%). The discharge destinations were: home (28.1%), hospital ward (35.1%), intensive care unit (30.7%), and surgery (4.4%); two patients died in the RR. With the univariate study, we identified risk factors for poor outcome: internal medical condition (52.5% vs 21.6%, p = 0.001) and age <2 years (55.6% vs 28.1%, p = 0.023). In the multivariate study, the medical cause was maintained as an independent risk factor (OR 4 (CI 95% 1.7-9.2), p = 0.001). CONCLUSIONS: The profile of the patient seen in the RR is of a school-age child in stable condition, arriving by ambulance for polytrauma. The children seen for internal medical reasons had poorer outcomes

Experiencia del paciente en Urgencias: ¿qué opinan los niños y los adolescentes? / Patient experience in emergency departments: what do children and adolescents think?

INTRODUCCIÓN: Mejorar la experiencia del paciente debe convertirse en una prioridad en los Servicios de Urgencias. En Pediatría, a menudo, se estudia la opinión de padres/cuidadores y no la de los niños directamente. El objetivo de este estudio es conocer la experiencia como paciente del paciente pediátrico ingresado desde el Servicio de Urgencias pediátricas. PACIENTES Y MÉTODOS: Estudio descriptivo prospectivo. Se diseña una encuesta basada en el cuestionario Picker sobre la experiencia del paciente que estudia la proporción de insatisfacción. Las encuestas son contestadas directamente por niños de 8-17 años que son visitados e ingresados desde Urgencias de un hospital terciario pediátrico. Se entregan las encuestas durante las primeras 24 h de ingreso de enero a mayo del 2014. RESULTADOS: Se obtienen 217 encuestas. La mediana de edad es de 12 años. Los niños piensan que la espera fue más larga de lo esperado (19,4%) y que las actividades de entretenimiento fueron inadecuadas (46,2%). Sobre la visita médica, el 4,6% piensa que el personal no explicó correctamente los procedimientos y para el 23% no tuvieron la suficiente privacidad. Sobre el conjunto de la visita, el 99,1% de los pacientes se sintió bastante o muy bien tratado. No se han encontrado diferencias en el grado de satisfacción en función del sexo, la edad o el tiempo de espera. CONCLUSIONES: Globalmente, la experiencia del paciente pediátrico en nuestro Servicio de Urgencias fue positiva. Algunos aspectos son susceptibles de mejora, como las actividades durante la espera y la privacidad durante la visita

INTRODUCTION: Improving patient experience must become a priority in paediatric emergency departments. This experience is often studied by surveying parents, and not children directly. The aim of this study was to assess the patient experience of children attended in a Paediatric Emergency Department (PED). PATIENTS AND METHODS: A prospective descriptive study was conducted using a survey based on the Picker questionnaire on the patient experience. From January to May 2014, children 8-17 years seen in the Paediatric Emergency Department and admitted to the hospital were asked to complete the questionnaires anonymously, within 24hours of admission. RESULTS: A total of 217 patients completed the survey. The responses showed the 19.4% had to wait longer than expected, with 46.2% saying that there was not enough for children of their age group to do while waiting to be seen. As regards care and treatment, 4.6% of participants said staff did not fully explain what they were doing, and 23% said that they were not given enough privacy when being examined. Overall, 99.1% of patients said that they were well treated. CONCLUSIONS: Overall patient experience in the PED was positive. Some aspects have to be improved (activities in the waiting room, and privacy during the examination)

Impacto de un programa de formación de catástrofes en el personal sanitario / Impact of a disaster preparedness training program on health staff

OBJETIVOS: Analizar la eficacia de un programa formativo sobre catástrofes en un Servicio de Urgencias Pediátricas (SUP). METODOLOGÍA: Estudio cuasiexperimental mediante encuestas dirigidas al personal sanitario del SUP de un hospital pediátrico de tercer nivel. Se evalúan aspectos teóricos y prácticos del plan de catástrofes (PC). Las encuestas son cumplimentadas en 2 periodos (periodo 1, enero del 2014, y periodo 2, noviembre del 2014), entre los cuales se realiza una formación con sesiones teóricas y situaciones clínicas. RESULTADOS: Se recogen 110 encuestas en el periodo 1 y 80 en el periodo 2. El 71,3% del personal asiste a las sesiones teóricas y el 43,8% a las prácticas. Tras la formación, aumenta significativamente la proporción del personal que conoce el PC y el «kit» de catástrofes. En cuanto a los aspectos prácticos, no se observa mejoría en las respuestas a las situaciones clínicas planteadas. El personal se siente más preparado para afrontar una catástrofe después del programa formativo (15,5% vs. 41,8%, p < 0,001). CONCLUSIONES: La aplicación de una formación sobre catástrofes ha mejorado algunos conocimientos del personal, pero no ha mejorado las respuestas en las situaciones clínicas planteadas, posiblemente influenciado por la baja asistencia a las sesiones prácticas y el tiempo transcurrido entre la formación y la encuesta

OBJECTIVES: The aim of this study is to evaluate the effectiveness of a disaster preparedness training program in a Paediatric Emergency Department (PED). METHODS: A quasi-experimental study was conducted using an anonymous questionnaire that was distributed to health care providers of a PED in a tertiary paediatric hospital. The questions concerned the disaster plan (DP), including theoretical and practical aspects. Questionnaires were distributed and completed in January 2014 (period 1) and November 2014 (period 2). The disaster training program includes theoretical and practical sessions. RESULTS: A total of 110 questionnaires were collected in period 1, and 80 in period 2. Almost three-quarters (71.3%) of PED staff attended the theoretical sessions, and 43.8% attended the practical sessions. The application of this training program significantly improved knowledge about the DP, but no improvement was observed in the practical questions. PED staff felt more prepared to face a disaster after the training program (15.5% vs. 41.8%, P<.001). CONCLUSIONS: The training program improved some knowledge about the disaster plan, but it has not improved responses in practical situations, which may be due to the low attendance at practical sessions and the time between the training program and the questionnaires

Presència dels pares durant els procediments invasius als serveis d'urgències pediàtriques. Què passa a l'Estat espanyol? / Presencia de los padres durante los procedimientos invasivos en los servicios de urgencias pediátricas. ¿Qué sucede en España? / No disponible

Fonament: la participació dels pares als serveis d'urgències pediàtriques (SUP) és important davant la realització de procediments invasius (PI). Objectiu: 1) Conèixer la freqüència de la presència dels pares davant els diferents PI als SUP de l'Estat espanyol. 2) Saber els motius pels quals es restringeix la seva presència. 3) Conèixer el grau d'acord del personal sanitari. Mètode: estudi descriptiu multicèntric, basat en enquestes dirigides als responsables dels diferents SUP d'Espanya. Resultats: En tots els hospitals els pares poden presenciar algun PI, com ara: sutura de ferides (23/32), punció lumbar (17/32) o maniobres de reanimació cardiopulmonar (RCP) (3/32); sense trobar diferències significatives segons les característiques dels hospitals. Entre els motius per restringir la presència dels pares destaquen la seva manca de preparació (17/31), un pitjor rendiment del personal sanitari (12/31) o l'ansietat dels pares (11/31). Ocasionalment (0-25%) se n'han derivat problemes, com el mareig (20/32) o la necessitat d'interrompre el procediment (13/32). El personal sanitari està d'acord amb la presència durant els procediments poc invasius (19/32), i poc o gens d'acord en els moderadament invasius (20/32) i en els molt invasius (30/32). Vint-i-set responsables creuen que és necessari fer programes de formació, grups de treball i protocols. Conclusions: tot i l'habitual presència dels pares durant els PI als nostres SUP, l'existència de motius que en restringeixen la presència i el baix grau d'acord del personal sanitari en algunes tècniques fan necessari el desenvolupament de programes formatius sobre els beneficis d'aquesta presència

Fundamentos. La participación de los padres en los servicios de urgencias pediátricas (SUP) es importante durante la realización de procedimientos invasivos (PI). Objetivo. 1) Conocer la frecuencia de la presencia de los padres durante los diferentes PI en los SUP españoles. 2) Conocer los motivos por los que se restringe su presencia. 3) Conocer el grado de acuerdo del personal sanitario. Método. Estudio descriptivo multicéntrico, basado en encuestas dirigidas a los responsables de diferentes SUP de España. Resultados. En todos los hospitales los padres pueden presenciar algún PI, como la sutura de heridas (23/32), la punción lumbar (17/32) o maniobras de reanimación cardiopulmonar (3/32), sin encontrarse diferencias significativas según las características de los hospitales. Entre los motivos para restringir su presencia destacan: la falta de preparación de los padres (17/31), un peor rendimiento del personal sanitario (12/31) o la ansiedad de los padres (11/31). Ocasionalmente (0-25%) se han derivado problemas, como el mareo (20/32) o la necesidad de interrupción del procedimiento (13/32). El personal sanitario está de acuerdo durante los procedimientos poco invasivos (19/32), y poco o nada de acuerdo en los moderadamente (20/32) y muy invasivos (30/32). Veintisiete responsables creen que es necesario realizar programas de formación, grupos de trabajo y protocolos. Conclusiones. A pesar de la habitual presencia de los padres durante los PI, la existencia de motivos que restringen su presencia y el bajo grado de acuerdo del personal sanitario en algunas técnicas hacen necesario el desarrollo de programas formativos sobre los beneficios de esta presencia (AU)

Background: the importance of parental involvement during invasive procedures (IP) in Pediatric Emergency Departments (PED) has been documented Objective: 1) To determine the frequency of parental presence during different IP in Spanish PED; 2) To assess the reasons for restricting their presence; and 3) To evaluate the agreement among healthcare professionals. Method: descriptive multicenter study based on questionnaires distributed among the chiefs of 32 Spanish PED. Results: family presence is allowed during some IP, including wound suture (23/32), lumbar puncture (17/32), or cardiopulmonary resuscitation (3/32), with no significant differences among hospitals. The main reasons for restricting parental presence are the perception of parents not being prepared to witness the procedure (17/31), the concern that their presence would adversely affect the performance by the healthcare provider (12/31), or parental anxiety (11/31). Occasionally, problems derived from the parental presence have been reported, such as dizziness (20/32) or the need to interrupt the procedure (13/32). Healthcare professionals agree with the presence of parents during some invasive procedures (19/23), but not during the most invasive ones (30/32). Twenty-seven PED chiefs stated the need to develop educational programs, working groups, and dedicated protocols to regulate the presence of parents during IP. Conclusions: despite the usual presence of parents during IP in the PED, the existence of reasons for restriction, as well as the lack of consistent agreement among healthcare professionals on the types of IP where parental presence should be permitted, highlights the need to develop educational initiatives about the benefits of paren-tal presence