ABSTRACT
OBJECTIVE: To evaluate the use of cerebrospinal fluid (CSF) ferritin levels in the diagnosis of purulent meningitis (PM). METHOD: We studied 81 children between 28 days and 12 years of age who presented with clinical suspicion of meningitis to the emergency department. CSF ferritin levels were measured and compared between diagnostic groups (PM, aseptic meningitis (AM) and no meningitis). RESULTS: The median age was 24 (IQR 8-69) months. There were 32 patients with AM (39%), 23 with PM (28%) and 26 with no meningitis (32%). Median CSF ferritin was 4.2 ng/mL (IQR 3.0-6.5), 52.9 ng/mL (IQR 30.7-103 ng/mL) and 2.4 ng/mL (IQR 2-4), respectively. CSF ferritin was higher in children with PM compared with AM (p<0.001) or no meningitis (p<0.001). There was no difference between AM and no meningitis. CONCLUSION: CSF ferritin may be a useful biomarker to discriminate PM in children with clinical symptoms of this disease.
Subject(s)
Cerebrospinal Fluid/metabolism , Ferritins/cerebrospinal fluid , Meningitis, Aseptic/cerebrospinal fluid , Meningitis, Bacterial/cerebrospinal fluid , Biomarkers/analysis , Brazil/epidemiology , Case-Control Studies , Cerebrospinal Fluid/microbiology , Child , Child, Preschool , Cross-Sectional Studies , Emergency Service, Hospital , Female , Hospitalization , Humans , Infant , Infant, Newborn , Male , Meningitis, Aseptic/diagnosis , Meningitis, Aseptic/microbiology , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/microbiologyABSTRACT
Objetivos: Revisar as principais medicações usadas em serviços de emergência pediátrica para analgesia em procedimentos terapêuticos.Fonte De Dados: Artigos científicos originais e de revisão das bases de dados MedLine/PubMed e LILACS, utilizando os termos sedação, analgesia, crianças, serviço de emergência e procedimentos dolorosos.Síntese Dos Dados: O manejo da dor, ansiedade e movimento, nas crianças submetidas a procedimentos dolorosos, tem se desenvolvido substancialmente nos últimos 20 anos. Fatores tais como tempo, logística e custos favorecem o tratamento no serviço de emergência, em oposição à sala cirúrgica. Uma ampla variedade de medicamentos está disponível. Os opioides e a cetamina têm sido as principais opções para analgesia e sedação em serviço de emergência pediátrica. Monitorização apropriada e avaliação constante são cuidados críticos para a segurança e efetividade do procedimento de sedação e analgesia na sala de emergência.Conclusões: Como não existe um medicamento único que se aplique a todas as situações que necessitam de sedação e analgesia em sala de emergência, a escolha é direcionada por múltiplos critérios como intensidade da dor, inicio de ação, duração de efeito, eventos adversos, experiência do serviço e custos.
Aims: To review the main pharmacological agents in pediatric emergency departments for painful procedures. Source Of Data: Scientific original and review articles from the MedLine/PubMed and LILACS databases, using the terms sedation, analgesia, children, emergency department and painful procedures. Summary Of Findings: The management of pain, anxiety and movement in children submitted to painful procedures has been substantially developed over the last 20 years. Factors such as time, logistics and costs favor the treatment in the emergency room as opposed to the operating room. A wide variety of medications are available. Opioids and ketamine are the main options for analgesia and sedation in the pediatric emergency department The proper monitoring and constant evaluation are critical care-steps for the safety and effectiveness of the procedure of sedation and analgesia in the emergency room. Conclusions: As there is not a unique drug that could be used in all situations needing sedation and analgesia in the pediatric emergence department, the choice is directed by multiple criteria such as pain intensity, onset of action, length of effect, adverse events, service experience and costs.
