[Utility of Pediatric Appendicitis Score and abdominal ultrasound in the diagnostic process of acute appendicitis]. / Utilidad del Pediatric Appendicitis Score y la ecografía abdominal en el proceso diagnóstico de apendicitis aguda.

INTRODUCTION: Pain in the right iliac fossa is a frequent reason for consultation and the diagnosis of appendicitis remains a challenge. The Pediatric Appendicitis Score (PAS) stratifies the risk of suffering appendicitis, and abdominal ultrasound provides information without irradiation. This study aims to correlate the score and the ultrasound with the screening of appendicitis and evaluate its efficiency. PATIENTS AND METHODS: Prospective study of cases and controls, analytical, observational and longitudinal. Patients <15 years of age, treated for suspected appendicitis in the emergency department of a II level center, were evaluated for 6 months. The data were analyzed univariate and bivariate, using nonparametric and parametric tests according to the distribution. RESULTS: 68 patients with pain in the right iliac fossa were included: 26 appendicitis (cases) (38.2%) and 42 (61.7%) other diagnoses (controls). The PAS in appendicitis was 7.5±1.8 and in other diagnoses 5.4±1.8 (p <0.01). At 70.5% with PAS ≥4 an ultrasound was performed (diagnosis of appendicitis 58.1%, discarded 25.6% and inconclusive 16.3%). Sensitivity and specificity were calculated by PAS groups only, and including ultrasound. The best result was for PAS ≥4 with ultrasound with a sensitivity of 96.2%, specificity 94.1%, PPV 96.1% and NPV 94.1%. CONCLUSIONS: PAS is a good screening tool for the diagnosis of appendicitis. Ultrasound presents a high efficiency for the diagnosis of appendicitis. This efficiency improves when performed in the group of patients with PAS ≥4.

INTRODUCCION: El dolor en fosa ilíaca derecha es un motivo frecuente de consulta y el diagnóstico de apendicitis sigue siendo un reto. El Pediatric Appendicitis Score (PAS) estratifica el riesgo de padecer apendicitis, y la ecografía abdominal aporta información sin irradiación. Este estudio pretende correlacionar su puntuación y la ecografía con el despistaje de apendicitis y valorar su rendimiento. MATERIAL Y METODOS: Estudio prospectivo de casos y controles, analítico, observacional y longitudinal. Se evaluó a los pacientes <15 años, atendidos por sospecha de apendicitis en urgencias de un centro de II nivel, durante 6 meses. Se analizaron los datos de forma univariante y bivariante, utilizando pruebas no paramétricas y paramétricas según la distribución. RESULTADOS: Se incluyeron 68 pacientes con dolor en fosa ilíaca derecha: 26 apendicitis (casos) (38,2%) y 42 (61,7%) otros diagnósticos (controles). El PAS en apendicitis fue de 7,5±1,8 y en otros diagnósticos de 5,4±1,8 (p <0,01). Al 70,5% con PAS ≥4 se les realizó una ecografía (diagnósticas de apendicitis 58,1%, descartaron 25,6% y no concluyentes 16,3%). Se calculó la sensibilidad y especificidad por grupos de PAS solamente, e incluyendo la ecografía. El mejor resultado fue para PAS ≥4 con realización de ecografía con una sensibilidad 96,2%, especificidad 94,1%, VPP 96,1% y VPN 94,1%. CONCLUSIONES: El PAS es una buena herramienta de cribado para el diagnóstico de apendicitis. La ecografía presenta un alto rendimiento para el diagnóstico de apendicitis. Este rendimiento mejora al realizarla en el grupo de pacientes con PAS ≥4.

Utilidad del Pediatric Appendicitis Score y la ecografía abdominal en el proceso diagnóstico de apendicitis aguda / Utility of Pediatric Appendicitis Score and abdominal ultrasound in the diagnostic process of acute appendicitis

Introducción: El dolor en fosa ilíaca derecha es un motivo frecuente de consulta y el diagnóstico de apendicitis sigue siendo un reto. El Pediatric Appendicitis Score (PAS) estratifica el riesgo de padecer apendicitis, y la ecografía abdominal aporta información sin irradiación. Este estudio pretende correlacionar su puntuación y la ecografía con el despistaje de apendicitis y valorar su rendimiento. Pacientes y métodos: Estudio prospectivo de casos y controles, analítico, observacional y longitudinal. Se evaluó a los pacientes <15 años, atendidos por sospecha de apendicitis en urgencias de un centro de II nivel, durante 6 meses. Se analizaron los datos de forma univariante y bivariante, utilizando pruebas no paramétricas y paramétricas según la distribución. Resultados: Se incluyeron 68 pacientes con dolor en fosa ilíaca derecha: 26 apendicitis (casos) (38,2%) y 42 (61,7%) otros diagnósticos (controles). El PAS en apendicitis fue de 7,5±1,8 y en otros diagnósticos de 5,4±1,8 (p<0,01). Al 70,5% con PAS ≥4 se les realizó una ecografía (diagnósticas de apendicitis 58,1%, descartaron 25,6% y no concluyentes 16,3%). Se calculó la sensibilidad y especificidad por grupos de PAS solamente, e incluyendo la ecografía. El mejor resultado fue para PAS ≥4 con realización de ecografía con una sensibilidad 96,2%, especificidad 94,1%, VPP 96,1% y VPN 94,1%. Conclusiones: El PAS es una buena herramienta de cribado para el diagnóstico de apendicitis. La ecografía presenta un alto rendimiento para el diagnóstico de apendicitis. Este rendimiento mejora al realizarla en el grupo de pacientes con PAS ≥4

Introduction: Pain in the right iliac fossa is a frequent reason for consultation and the diagnosis of appendicitis remains a challenge. The Pediatric Appendicitis Score (PAS) stratifies the risk of suffering appendicitis, and abdominal ultrasound provides information without irradiation. This study aims to correlate the score and the ultrasound with the screening of appendicitis and evaluate its efficiency. Patients and methods: Prospective study of cases and controls, analytical, observational and longitudinal. Patients <15 years of age, treated for suspected appendicitis in the emergency department of a II level center, were evaluated for 6 months. The data were analyzed univariate and bivariate, using nonparametric and parametric tests according to the distribution. Results: 68 patients with pain in the right iliac fossa were included: 26 appendicitis (cases) (38.2%) and 42 (61.7%) other diagnoses (controls). The PAS in appendicitis was 7.5±1.8 and in other diagnoses 5.4±1.8 (p <0.01). At 70.5% with PAS ≥4 an ultrasound was performed (diagnosis of appendicitis 58.1%, discarded 25.6% and inconclusive 16.3%). Sensitivity and specificity were calculated by PAS groups only, and including ultrasound. The best result was for PAS ≥4 with ultrasound with a sensitivity of 96.2%, specificity 94.1%, PPV 96.1% and NPV 94.1%. Conclusions: PAS is a good screening tool for the diagnosis of appendicitis. Ultrasound presents a high efficiency for the diagnosis of appendicitis. This efficiency improves when performed in the group of patients with PAS ≥4

[Bicycle accidents treated in emergency departments. A multicentre study]. / Accidentes de bicicleta atendidos en los Servicios de Urgencias. Estudio multicéntrico.

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.

Estudio multicéntrico sobre factores de riesgo de lesiones en accidentes de automóvil / Multicentre study on risk factors of injuries in car crashes

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)

[Multicentre study on risk factors of injuries in car crashes]. / Estudio multicéntrico sobre factores de riesgo de lesiones en accidentes de automóvil.

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.

Epidemiología y hallazgos clínicos de la sepsis neonatal tardía en la unidad de cuidados intensivos pediátricos / Epidemiology and clinical findings in late-onset neonatal sepsis in the pediatric intensive care unit

No disponible

Atresia de esófago long-gap: repercusión del momento de la extubación en la evolución / Long-gap esophageal atresia: effect of the timing of extubation on outcome

No disponible

Propuesta de actuación ante la sospecha de la ingesta accidental de un paquete con droga (“Body packing”) / An intervention proposal in the presence of suspected accidental drug packet intake (body packing)

No disponible

[Doxycycline-induced esophagitis: report of two cases]. / Esofagitis por doxiciclina. A propósito de dos casos.

Drug-induced esophagitis has frequently been reported in adults, with more than 100 substances involved. However, only a few cases occurring in the pediatric population have been published. The most frequently involved drugs are antibiotics and the incidence of esophagitis is thought to be greater than estimated due to the increase in antibiotic prescription in the last few decades. A medical history suggestive of retrosternal pain, odynophagia with or without dysphagia, and recent drug intake are suspicious for this entity. Although most cases are self-limiting, complications such as hemorrhage or perforation have been described. We present two cases of doxycycline-induced esophagitis in two teenagers that illustrate the clinical course, endoscopic pattern and treatment of this entity.

Esofagitis por doxiciclina. A propósito de dos casos / Doxycycline-induced esophagitis: report of two cases

La esofagitis por fármacos es una entidad descrita con relativa frecuencia en adultos y en la que se han implicado alrededor de 100 sustancias. Sin embargo, son escasas las publicaciones que hacen referencia a casos en la población pediátrica. Los fármacos más asociados son los antibióticos y se cree que la incidencia es mayor a la estimada dado el aumento de prescripción de éstos en las últimas décadas. La historia clínica indicativa de dolor retroesternal, odinofagia con o sin disfagia y el antecedente de ingesta de fármaco en un paciente debe hacer pensar en esta entidad. La mayoría de los casos son autolimitados, pero no hay que olvidar que pueden asociarse a complicaciones como hemorragias o perforaciones. Los 2 casos que se presenta ilustran la sintomatología, los hallazgos endoscópicos y el tratamiento en esofagitis por doxiciclina en dos adolescentes

Drug-induced esophagitis has frequently been reported in adults, with more than 100 substances involved. However, only a few cases occurring in the pediatric population have been published. The most frequently involved drugs are antibiotics and the incidence of esophagitis is thought to be greater than estimated due to the increase in antibiotic prescription in the last few decades. A medical history suggestive of retrosternal pain, odynophagia with or without dysphagia, and recent drug intake are suspicious for this entity. Although most cases are self-limiting, complications such as hemorrhage or perforation have been described. We present two cases of doxycycline–induced esophagitis in two teenagers that illustrate the clinical course, endoscopic pattern and treatment of this entity