ABSTRACT
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: La punción lumbar (PL) es una técnica ampliamente utilizada en pediatría. La realización adecuada de la técnica puede evitar la mayoría de las complicaciones asociadas. Objetivo: Evaluar si en España los pediatras y los residentes de pediatría siguen las recomendaciones de la técnica de la PL. Material y métodos: Estudio transversal basado en un cuestionario escrito distribuido por correo electrónico a través de la Sociedad Española de Urgencias Pediátricas, que recogía datos epidemiológicos y preguntas de respuesta múltiple sobre la realización de la PL. Resultados: Se analizaron 206 cuestionarios, 143 (69,5%) respondidos por pediatras y 63 (30,5%) por residentes de pediatría. Hacen la PL sin los padres presentes 128 médicos (62,1%), aplican sedoanalgesia 198 (96,1%); 84 (42%) sólo analgesia local. Colocan al paciente sentado 108 (53,7%). La mayoría utiliza aguja tipo Quincke (126; 62,7%), orienta bien el trocar al hacer la punción 22 (36,1%) residentes y 21 pediatras (15,1%), diferencia estadísticamente significativa (p=0,001). En los neonatos, 63 (46%) pediatras y 19 (30,2%) residentes usan aguja sin fiador tipo «palomilla», diferencia también significativa (p=0,035). Reintroducen el estilete para redirigir el trocar 190 (92,2%) encuestados y para extraerlo 186 (93%). Recomiendan reposo tras la PL 195 (94,7%) médicos. Conclusiones: La mayoría de los pediatras orientan mal el trocar cuando hacen una PL y siguen utilizando aguja tipo «palomilla» en los neonatos a pesar de que está desaconsejado. Los residentes de pediatría y los pediatras con menor experiencia siguen las recomendaciones con mayor frecuencia(AU)
Introduction: Lumbar puncture (LP) is a commonly performed procedure in paediatrics. Performing this technique properly can avoid the most common associated complications. Objective: To assess whether paediatricians and paediatric residents in Spain follow current recommendations for the LP technique. Material and methods: A cross-sectional study was conducted by sending a questionnaire by mail through the Spanish Society of Paediatric Emergencies, collecting demographic information and responses to multiple choice questions about LP technique. Results: A total of 206 questionnaires were analysed, of which 143 (69.5%) were answered by paediatricians, and 63 (30.5%) by paediatric residents. The majority (128; 62.1%) of physicians did not allow parents to be present during LP, 198 (96.1%) routinely use analgesia and sedation; 84 (42%) only used local anaesthesia. The majority of respondents used standard Quincke needles (126; 62.7%). The bevel was correctly positioned when puncturing the dura mater by 22 residents (36.1%) and 21 paediatricians (15.1%), a variation that was statistically significant (P=.001). For neonatal lumbar punctures, 63 paediatricians (46%) and 19 paediatric residents used a butterfly needle which did not contain a stylet, and this difference was also statistically significant (P=.035). Of those surveyed, 190 (92.2%) re-inserted the stylet when re-orientating the needle, and 186 (93%) re-oriented this when removing it. The recommendation of bed rest was made by 195 (94.7%) physicians. Conclusions: The majority of paediatricians orient the bevel wrongly when inserting the needle during LP, and still use "butterfly" needles in newborns, despite warnings to the contrary. Paediatric residents and less experienced paediatricians follow the recommendations more frequently(AU)
Subject(s)
Humans , Male , Female , Child , Spinal Puncture/methods , Spinal Puncture , Post-Dural Puncture Headache/complications , Post-Dural Puncture Headache/diagnosis , Angioedema/complications , Angioedema/diagnosis , Conscious Sedation/methods , Analgesia/methods , Analgesia , Surveys and Questionnaires/standards , Spinal Puncture/standards , Spinal Puncture/trends , Post-Dural Puncture Headache/drug therapy , Angioedema/physiopathology , Angioedema , Cross-Sectional Studies/methods , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
INTRODUCTION: Lumbar puncture (LP) is a commonly performed procedure in paediatrics. Performing this technique properly can avoid the most common associated complications. OBJECTIVE: To assess whether paediatricians and paediatric residents in Spain follow current recommendations for the LP technique. MATERIAL AND METHODS: A cross-sectional study was conducted by sending a questionnaire by mail through the Spanish Society of Paediatric Emergencies, collecting demographic information and responses to multiple choice questions about LP technique. RESULTS: A total of 206 questionnaires were analysed, of which 143 (69.5%) were answered by paediatricians, and 63 (30.5%) by paediatric residents. The majority (128; 62.1%) of physicians did not allow parents to be present during LP, 198 (96.1%) routinely use analgesia and sedation; 84 (42%) only used local anaesthesia. The majority of respondents used standard Quincke needles (126; 62.7%). The bevel was correctly positioned when puncturing the dura mater by 22 residents (36.1%) and 21 paediatricians (15.1%), a variation that was statistically significant (P=.001). For neonatal lumbar punctures, 63 paediatricians (46%) and 19 paediatric residents used a butterfly needle which did not contain a stylet, and this difference was also statistically significant (P=.035). Of those surveyed, 190 (92.2%) re-inserted the stylet when re-orientating the needle, and 186 (93%) re-oriented this when removing it. The recommendation of bed rest was made by 195 (94.7%) physicians. CONCLUSIONS: The majority of paediatricians orient the bevel wrongly when inserting the needle during LP, and still use "butterfly" needles in newborns, despite warnings to the contrary. Paediatric residents and less experienced paediatricians follow the recommendations more frequently.
