ABSTRACT
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Subject(s)
Child , Humans , Male , Bone Cysts, Aneurysmal/pathology , Bone Cysts, Aneurysmal , Immunization , Ankle Injuries/pathology , Ankle Injuries , Ankle , Insufflation/methods , Insufflation/standards , Biopsy, Needle/instrumentation , Biopsy, Needle/methods , Biopsy, Needle , Magnetic Resonance Imaging/methods , Magnetic Resonance Spectroscopy/methodsABSTRACT
OBJECTIVES: To describe epidemiological characteristics, types of injury, prognosis and medical management of bicycle-related Paediatric Emergency Department (ED) visits and to identify potential preventive measures. PATIENTS AND METHODS: This multicentred, observational prospective study included all children between 3 and 16 years of age treated for bicycle-related injuries in the Emergency Departments of 15 Spanish Hospitals belonging to the «Unintentional Paediatric Injury Workshop¼ of the Spanish Paediatric Emergency Society between the 1(st) of June 2011 and the 31(st) of May 2012. Characteristics of all ED visits, as well as epidemiological data and accident-related information, were collected. RESULTS: A total of 846 patients were included in the study, with a male predominance (72.9%) and a median age of 9.6 ± 3.6 years. Head injury was the third most common injury (22.3%) and the main cause of admission to the Pediatric Intensive Care Unit (PICU) (68.4%). More than three-quarters (77.9%) of the patients did not wear a helmet, which was significantly associated to a higher incidence of head injury and admission to PICU. Older children (OR 1.063) and bicycle injuries involving motor vehicles (OR 2.431) were identified as independent risk factors for worse outcomes. CONCLUSIONS: Since helmet use reduces up to 88% of central nervous system lesions secondary to head injury, promotion of its use should be the main preventive measure, followed by restriction of bike-riding to cycling areas.
Subject(s)
Accidents, Traffic/statistics & numerical data , Bicycling/injuries , Adolescent , Child , Child, Preschool , Emergency Service, Hospital , Female , Humans , Male , Prospective Studies , Spain , Wounds and Injuries/epidemiology , Wounds and Injuries/therapyABSTRACT
Introducción: Los accidentes de tráfico son la principal causa de muerte en niños de entre 2 y 14 años en países desarrollados. En este estudio se analiza la repercusión clínica, las características epidemiológicas, el uso y la adecuación de los sistemas de retención infantil (SRI) y su correlación con el tipo de lesiones en menores de 12 años de edad. Material y métodos: Estudio multicéntrico prospectivo descriptivo. Se recogieron los datos de filiación de las víctimas, los detalles técnicos de los accidentes, el uso y la adecuación del SRI, la clasificación de las lesiones según la localización y la gravedad, la necesidad de hospitalización, el tratamiento médico recibido, la activación del sistema de emergencias y el destino final del lesionado. Resultados: Se estudiaron 366 pacientes, la relación por sexos fue 1:1 y la mediana de edad fue de 6 años. El 69,7% presentó alguna lesión (el 92,3% eran lesiones leves). El 81,1% de las lesiones afectaron la cabeza y el cuello. El 77,9% utilizó algún tipo de SRI (adecuado sólo en el 55,7%). Se encontró mayor infrautilización del SRI en mayores de 6 años (27,1%; p<0,001). Circular en vía interurbana (odds ratio [OR]: 6,7) y no utilizar SRI adecuado (OR: 3,7) se relacionaron con la gravedad de las lesiones. La edad de los pacientes y la posición dentro del automóvil no estuvieron relacionadas. Todos los pacientes con escala de coma de Glasgow inferior a 8 y todos los pacientes fallecidos llevaban SRI inadecuados. Requirieron hospitalización el 8,7% y la tasa de mortalidad a las 24h fue del 0,8%. Conclusiones: Un porcentaje importante de los niños accidentados no utiliza SRI adecuados. La no utilización de un SRI o su utilización inadecuada es un factor de riesgo de morbilidad en los accidentes de tráfico en la infancia (AU)
Introduction: Traffic accidents are the main cause of death in children between 2 and 14 years in developed countries. We analysed their clinical repercussions, epidemiological characteristics, use and suitability of Child Restraint Systems (CRS) and its correlation with the type of injuries in children less than 12 years old. Material and methods: Multicentre descriptive prospective study. The following data was collected: personal details of the victims and the type of accident, use and suitability of the CRS, classification of injuries according to location and severity, need for hospitalisation, medical treatment received, use of Emergency Services and final destination of the injured. Results: A total of 366 patients were studied, with a sex ratio of 1:1 and a mean age of 6 years. Of these, 69.7% had some injury (slight 92.3%). A total of 81.1% affected the head and neck, and 77.9% used some type of CRS (suitable only in 55.7%). CRS were used more in >6 year olds (27.1%-P<0.001). Driving long distances (odds ratio 6.7) and not using a suitable CRS (odds ratio 3.7) were associated with the severity of the injuries. The age of the patients and the position within the automobile were not related. All the patients with a Glasgow less than 8 and all the deceased were using an unsuitable CRS. The hospitalization rate was 8.7% and the mortality rate at 24h was 0.8%. Conclusions: An important percentage of the injured children do not use suitable child restraint systems. Non-use of a CRS or its inadequate use is a risk factor of morbidity in the traffic accidents in childhood (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Accidents, Traffic/statistics & numerical data , Multiple Trauma/epidemiology , Accidents/mortality , Hospitalization , Neck Injuries/epidemiology , Craniocerebral Trauma/epidemiology , Glasgow Coma Scale , Multicenter Studies as Topic , Risk Factors , Protective DevicesABSTRACT
INTRODUCTION: Traffic accidents are the main cause of death in children between 2 and 14 years in developed countries. We analysed their clinical repercussions, epidemiological characteristics, use and suitability of Child Restraint Systems (CRS) and its correlation with the type of injuries in children less than 12 years old. MATERIAL AND METHODS: Multicentre descriptive prospective study. The following data was collected: personal details of the victims and the type of accident, use and suitability of the CRS, classification of injuries according to location and severity, need for hospitalisation, medical treatment received, use of Emergency Services and final destination of the injured. RESULTS: A total of 366 patients were studied, with a sex ratio of 1:1 and a mean age of 6 years. Of these, 69.7% had some injury (slight 92.3%). A total of 81.1% affected the head and neck, and 77.9% used some type of CRS (suitable only in 55.7%). CRS were used more in >6 year olds (27.1%-P<0.001). Driving long distances (odds ratio 6.7) and not using a suitable CRS (odds ratio 3.7) were associated with the severity of the injuries. The age of the patients and the position within the automobile were not related. All the patients with a Glasgow less than 8 and all the deceased were using an unsuitable CRS. The hospitalization rate was 8.7% and the mortality rate at 24h was 0.8%. CONCLUSIONS: An important percentage of the injured children do not use suitable child restraint systems. Non-use of a CRS or its inadequate use is a risk factor of morbidity in the traffic accidents in childhood.
Subject(s)
Accidents, Traffic/statistics & numerical data , Wounds and Injuries/epidemiology , Child , Female , Humans , Male , Prospective Studies , Risk FactorsABSTRACT
Purpura fulminans (PF) is an infrequent complication of varicella characterized by the progressive development of purpuric or painful ecchymotic lesions associated with biochemical alternations typical of consumption coagulopathy. Activation of coagulation is due to a marked and prolonged decrease in protein S, which is probably secondary to the formation of antiprotein S antibodies. The mechanism responsible for the synthesis of these autoantibodies is unknown. We present three cases of postvaricella PF and review the clinical and biochemical characteristics of this entity, as well as current diagnostic and therapeutic recommendations.
Subject(s)
Chickenpox/complications , IgA Vasculitis/etiology , Antibodies , Autoantibodies , Chickenpox/immunology , Child , Child, Preschool , Female , Humans , IgA Vasculitis/diagnosis , Male , Protein S/immunologyABSTRACT
La púrpura fulminante es una complicación rara de la varicela que se caracteriza por la aparición progresiva de lesiones purpúricas o equimóticas dolorosas asociado a una alteración analítica propia de una coagulopatía de consumo. La activación de la coagulación es debida a un descenso marcado y prolongado de la proteína S, que probablemente es secundario a la formación de anticuerpos antiproteína S. El mecanismo responsable de la síntesis de estos autoanticuerpos es desconocido. Se presentan 3 casos de púrpura fulminante posvaricelosa y se revisan las características clinicoanalíticas y las recomendaciones diagnosticoterapéuticas actuales de esta entidad (AU)
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Autoantibodies , Chickenpox , Antibodies , Protein S , IgA VasculitisABSTRACT
Objetivos: Analizar los motivos de readmisión con ingreso de pacientes que han sido atendidos previamente en las anteriores 72 horas en un servicio de urgencias pediátrico. Método: Revisión retrospectiva de 487 historias clínicas correspondientes a los pacientes atendidos en urgencias y readmitidos con ingreso en 72 horas en un período de estudio de 8 meses. Los motivos de ingreso se clasificaron en: progresión de la enfermedad, orientación inicial diagnóstica y/o terapéutica inadecuadas, evaluación médica inicial incompleta, motivos familiares, control, no relacionada con la primera visita y no determinable. Resultados: Durante el período de estudio, se atendieron un total de 49.288 visitas en urgencias, la tasa de nuevas consultas fue del 6,45 por ciento. Un 15,3 por ciento de los pacientes que volvieron a consultar fueron ingresados. El motivo de readmisión con ingreso más frecuente (59,3 por ciento) fue la progresión de la enfermedad (fundamentalmente en patología respiratoria y gastroenteritis agudas), en 6 casos (1,2 por ciento) fue una orientación inicial diagnóstica o terapéutica inadecuada y en 24 (4,9 por ciento) una evaluación inicial incompleta; los factores familiares fueron la causa del ingreso en 87 casos (17,8 por ciento).Conclusiones: Las causas de readmisión con ingreso se deben fundamentalmente a progresión de la enfermedad o a motivos familiares y son, por tanto, poco susceptibles de intervención. No obstante, la aplicación periódica de este indicador puede ser un instrumento útil ya que la detección de variaciones en las causas nos pondría informar sobre la necesidad de implantar programas de mejora específicos (AU)
