Setting priorities for an agenda within the Spanish pediatric emergency medicine research network.

The research network of the Spanish Pediatric Emergency Society (RISeuP-SPERG Network) needs to establish its research agenda relevant to pediatric emergency medicine (PEM) to guide the development of future projects, as other networks have done before. The aim of our study was to identify priority areas in PEM for a collaborative network of pediatric emergency research in Spain. A multicenter study was developed including pediatric emergency physicians from 54 Spanish emergency departments, endorsed by the RISeuP-SPERG Network. Initially, a group of seven PEM experts was selected among the members of the RISeuP-SPERG. In the first phase, these experts elaborated a list of research topics. Then, using a Delphi method, we sent a questionnaire with that list to all RISeuP-SPERG members, to rank each item using a 7-point Likert scale. Finally, the seven PEM experts, using a modified Hanlon Process of Prioritization, weighted prevalence (A), seriousness of the condition (B), and feasibility of conducting research projects (C) on that condition to prioritize the selected items. Once the list of topics was chosen, the seven experts selected a list of research questions for each of the selected items. The Delphi questionnaire was answered by 74/122 (60.7%) members of RISeuP-SPERG. We established a list of 38 research priorities related to quality improvement (11), infectious diseases (8), psychiatric/social emergencies (5), sedoanalgesia (3), critical care (2), respiratory emergencies (2), trauma (2), neurologic emergencies (1), and miscellanea (4).   Conclusion: The RISeuP-SPERG prioritization process identified high-priority PEM topics specific to multicenter research that may help guide further collaborative research efforts within the RISeuP-SPERG network to improve PEM care in Spain. What is Known: • Some pediatric emergency medicine networks have established their priorities for research. What is New: • After a structured process, we have set the research agenda for pediatric emergency medicine in Spain. By identifying high-priority pediatric emergency medicine research topics specific to multicenter research, we may guide further collaborative research efforts within our network.

Multisystem inflammatory syndrome in children and SARS-CoV-2 variants: a two-year ambispective multicentric cohort study in Catalonia, Spain.

Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical, and laboratory findings of all MIS-C cases diagnosed in children < 18 years old in Catalonia (Spain) to study their trend throughout the pandemic. This was a multicenter ambispective observational cohort study (April 2020-April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR). Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. The monthly MIS-C incidence was 4.1 (95% CI: 3.4-4.8) per 1,000,000 people, and 273 (95% CI: 230-316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, the MIS-C RR was 8.2 (95% CI: 5.7-11.7) per 1,000,000 SARS-CoV-2 infections, which was significantly lower (p < 0.001) than that for previous variant periods in all age groups. The median [IQR] age of MIS-C was 8 [4-11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39 °C (81.6%); nearly 40% had an abnormal echocardiography, and 7% had coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05).  Conclusion: The RR between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic. What is Known: • Before our study, only two publications investigated the incidence of MIS-C regarding SARS-CoV-2 variants in Europe, one from Southeast England and another from Denmark. What is New: • To our knowledge, this is the first study investigating MIS-C incidence in Southern Europe, with the ability to recruit all MIS-C cases in a determined area and analyze the rate ratio for MIS-C among SARS-CoV-2 infections throughout variant periods. • We found a lower rate ratio of MISC/infections with SARS-CoV-2 in the Omicron period for all age groups, including those not eligible for vaccination, suggesting that the variant could be the main factor for this shift in the MISC trend.

Effectiveness of Procedural Sedation and Analgesia in Pediatric Emergencies. A Cross-Sectional Study.

INTRODUCTION: Pain is defined as an unpleasant emotional and sensory experience associated with bodily harm or with situations that cause fear and anxiety. However, it is often undertreated in pediatric emergency departments. This study aims to assess the effectiveness of sedation-analgesia techniques, level of satisfaction among health care professionals and relatives, and agreement between the satisfaction of health care professionals and relatives. METHODS: A cross-sectional design was conducted. Sociodemographic and clinical variables were recorded, together with those for effectiveness using the Face, Legs, Activity, Cry, and Consolability scale and the Wong-Baker FACES scale, and the satisfaction using the 10-point Likert scale. Stata 16.1 was used for data analysis. RESULTS: A total of 94 procedures were registered. The results suggested that these techniques were effective or mildly effective in only half of the cases. Satisfaction was considered good across the board, and the agreement between health care professionals (ie, pediatric nurses and pediatricians) was considered substantial. However, the agreement between health care professionals and relatives was moderate. DISCUSSION: Our results suggested that the adequate management of pain in pediatric emergency departments is still a challenge, despite the availability of international guidelines. Future research lines should be focused on analyzing possible causes of the inefficacy of some sedation-analgesia techniques and the causes of the differences between the perspectives of health care professionals and relatives. These research lines may be useful to improve quality of care and pediatric patient comfort.

Multisystem Inflammatory Syndrome in Children in Western Countries? Decreasing Incidence as the Pandemic Progresses?: An Observational Multicenter International Cross-sectional Study.

BACKGROUND: SARS-CoV-2 variations as well as immune protection after previous infections and/or vaccination may have altered the incidence of multisystemic inflammatory syndrome in children (MIS-C). We aimed to report an international time-series analysis of the incidence of MIS-C to determine if there was a shift in the regions or countries included into the study. METHODS: This is a multicenter, international, cross-sectional study. We collected the MIS-C incidence from the participant regions and countries for the period July 2020 to November 2021. We assessed the ratio between MIS-C cases and COVID-19 pediatric cases in children <18 years diagnosed 4 weeks earlier (average time for the temporal association observed in this disease) for the study period. We performed a binomial regression analysis for 8 participating sites [Bogotá (Colombia), Chile, Costa Rica, Lazio (Italy), Mexico DF, Panama, The Netherlands and Catalonia (Spain)]. RESULTS: We included 904 cases of MIS-C, among a reference population of 17,906,432 children. We estimated a global significant decrease trend ratio in MIS-C cases/COVID-19 diagnosed cases in the previous month ( P < 0.001). When analyzing separately each of the sites, Chile and The Netherlands maintained a significant decrease trend ( P < 0.001), but this ratio was not statistically significant for the rest of sites. CONCLUSIONS: To our knowledge, this is the first international study describing a global reduction in the trend of the MIS-C incidence during the pandemic. COVID-19 vaccination and other factors possibly linked to the virus itself and/or community transmission may have played a role in preventing new MIS-C cases.

Recomendaciones en soporte vital pediátrico 2021, novedades y adaptaciones en España / Pediatric life support guidelines 2021, novelties and adaptations in Spain

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Conocimientos y retos sobre COVID-19 y población pediátrica / Knowledge and challenges on COVID-19 and the paediatric population

La pandemia del SARS-CoV-2 nos plantea muchas reflexiones y un futuro incierto. Pero, también ha sido una oportunidad para abrir nuevos retos en la investigación pediátrica. En Cataluña se constituyó un grupo de investigación multidisciplinario (COPEDI-CAT) formado por pediatras de hospital y de Atención Primaria y físicos de la unidad de Biología Computacional y Sistemas Complejos (BIOCOM-SC) de la Universidad Politécnica de Cataluña para dar respuesta a algunas de las incógnitas que nos generaba la enfermedad por SARS-CoV-2 en la edad pediátrica. En un primer estudio, al inicio de pandemia, demostramos que los niños y adolescentes no eran los motores de la propagación del virus: el 70% de los casos positivos se contagiaron de algún adulto conviviente y solamente el 7,7% fueron los casos índice dentro del núcleo familiar. En otro estudio realizado para conocer la transmisión del virus en los grupos burbuja de las escuelas, se observó que el 75% de los casos positivos no contagiaron a ningún compañero del grupo. También constatamos que la mayor parte de los niños y adolescentes eran asintomáticos o padecían la COVID-19 de forma leve y evolucionaban favorablemente. Las hospitalizaciones y las complicaciones están descritas, pero son muy poco frecuentes. En la quinta ola, la variante delta del SARS-CoV-2 ha afectado mucho más a los niños (20%) que en las anteriores olas. Gracias al esfuerzo y a la inversión realizada, la investigación ha dado sus frutos y ya disponemos de vacunas eficaces y seguras. Las vacunas nos han situado en un escenario mucho más optimista, pero con toda la información científica disponible y con la variante delta predominante, es inevitable plantearse si la vacunación en los menores de 12 años podría ofrecerles ventajas, a ellos y a la población general (AU)

The SARS-CoV-2 pandemic has given us many reflections and an uncertain future. But it has also been an opportunity to open to new challenges in paediatric research. In Catalonia, a multidisciplinary research group (COPEDI-CAT) formed by hospital and primary care paediatricians and physicists from the Computational Biology and Complex Systems Unit (BIOCOM-SC) of the Polytechnic University of Catalonia was set up to answer some of the unknowns about SARS-CoV-2 infection in the paediatric age group. In a first study, at the beginning of the pandemic, we demonstrated that children and adolescents were not the driving force behind the spread of the virus: 70% of the positive cases were transmitted by a cohabiting adult and only 7.7% were index cases within the family nucleus. In another study on the transmission of the virus in school bubble groups, we found that 75% of the positive cases did not infect any of their peers. We also found that most of the children and adolescents were asymptomatic or had mild COVID-19 and were progressing favourably. Hospitalisations and complications are described but are very rare. In the fifth wave, the SARS-CoV-2 delta variant has affected significantly more children (20%) than in previous waves. Thanks to the effort and investment made, research has borne fruit and we now have effective and safe vaccines. Vaccines have put us in a much more optimistic scenario, but with all the scientific information available and with the predominant delta variant, it is inevitable to ask... (AU)

[Paediatric Life Support]. / Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS): Leitlinien des European Resuscitation Council 2021.

The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.

Fonaments bàsics de les vacunes contra la covid-19 / Fundamentos básicos de las vacunas contra la covid-19 / Basics of covid-19 vaccines

A començaments de l’any 2020 s’estén arreu del món unapandèmia provocada pel SARS-CoV-2, un virus respiratoriemergent procedent de la Xina i causant de la malaltiaconeguda com a covid-19. D’aleshores ençà, l’obtenciód’una vacuna ha esdevingut una cursa contrarellotge arreudel món. Equips d’investigació d’universitats i farmacèuti-ques assagen vacunes basades en diferents tecnologies,algunes ja utilitzades històricament i altres de nova gene-ració. Actualment n’hi ha centenars en diferents fasesd’investigació. Això, juntament amb el gran impacte quegenera la malaltia a la societat, fa que estiguem sotmesosa una allau constant d’informació sobre les vacunes contrala covid-19. Aquest treball de revisió pretén aclarir algunsconceptes que ens permetin ser crítics amb la informaciórebuda i, al mateix temps, aclarir termes i generalitats so-bre els diferents tipus de vacunes, la seva regularització,producció i efectes secundaris.(AU)

A comienzos de 2020 se extiende por el mundo una pandemiaprovocada por el virus SARS-CoV-2, un virus respiratorio emer-gente procedente de China y causante de la enfermedad conocidacomo covid-19. A partir de entonces, la obtención de una vacunase ha convertido en una carrera contrarreloj alrededor del mundo.Equipos de investigación de universidades y farmacéuticas ensa-yan vacunas basadas en diferentes tecnologías, algunas ya utiliza-das históricamente y otras de nueva generación. Actualmente haycentenares en diferentes fases de investigación. Esto, junto con elgran impacto que genera la enfermedad en la sociedad, hace queestemos sometidos a un alud constante de información sobre lasvacunas contra la covid-19. Este trabajo de revisión pretende acla-rar algunos conceptos que nos permitan una lectura crítica de lainformación y aclarar simultáneamente términos y generalidadessobre los diferentes tipos de vacunas, su regularización, produc-ción y efectos secundarios.(AU)

Early in 2020, a pandemic caused by a new respiratory virus na-med SARS-CoV-2 -causing the COVID-19 disease- extended aroundthe world from China. From that moment on a global race for thevaccine commenced at universities and the pharmaceutical indus-try using different methods and technologies, including both tradi-tional and new generation strategies. Nowadays, hundreds of themare under different phases of development. This, along with thestrong social impact of the disease, floods social media with infor-mation about the progresses of the different working groups. Thispaper sheds light on concepts that allow one to scrutinize suchinformation critically and clarify terms and generalities about diffe-rent vaccines, their regularization, production and side effects.(AU)

European Resuscitation Council Guidelines 2021: Paediatric Life Support.

These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.

Suport vital pediàtric bàsic I avançat. Recomanacions per a la covid-19 del Consell Europeu de Ressuscitació (ERC) / Soporte vital pediátrico básico y avanzado. Recomendaciones para la Covid-19 del Consejo Europeo de Reanimación (ERC) / Basic and advanced pediatric life support. European Resuscitation Council (ERC) Covid-19 guidelines

Suport vital pediàtric bàsic I avançat. Recomanacions per a la covid-19 del Consell Europeu de Ressuscitació (ERC) El grup de redacció de guies pediàtriques de l'ERC ha fet una adaptació «temporal» de les seves recomanacions a l'època de la covid-19. Aquestes s'han d'interpretar dins del context de cada sistema sanitari, considerant el grau de propagació de la malaltia I la seva evolució dins de cada regió, així com l'impacte general sobre els recursos disponibles. Donada l'evidència limitada, les pautes següents són principalment el resultat del consens d'experts. Es fa referència a la protecció de personal sanitari I no sanitari, al reconeixement de l'infant greument malalt, al maneig de la via aèria I la respiració de l'infant críticament malalt amb possible covid-19, al reconeixement de l'aturada cardíaca en infants I l'algoritme de suport vital bàsic, a l'obstrucció de la via aèria per cos estrany, al suport vital avançat I a l'ètica de la reanimació en infants durant la pandèmia de covid-19

El grupo de redacción de guías pediátricas de ERC ha realizado una adaptación «temporal» de sus recomendaciones en la época de la covid-19. Estas deben interpretarse dentro del contexto de cada sistema sanitario, considerando el grado de propagación de la enfermedad y su evolución dentro de esa región, así como el impacto general sobre los recursos disponibles. Dada la evidencia limitada, las siguientes pautas son principalmente el resultado del consenso de expertos. Se hace referencia a la protección de personal sanitario y no sanitario, al reconocimiento del niño gravemente enfermo, al manejo de la vía aérea y la respiración del niño críticamente enfermo con posible covid-19, al reconocimiento de la parada cardíaca en niños y al algoritmo de soporte vital básico, a la obstrucción de la vía aérea por cuerpo extraño, al soporte vital avanzado y a la ética de la reanimación en niños durante la pandemia de covid-19

The ERC paediatric guideline writing group has "temporarily" adapted their recommendations to the context of covid-19. These should be interpreted within the context of each healthcare system, considering the degree of covid-19 spread and evolving disease profile within that region, and the overall impact on available resources. Given the limited evidence, the following guidelines are mainly the result of expert consensus. Reference is made to the protection of bystanders and healthcare professionals, to the recognition of the critically ill child, to the airway and breathing management of a critically child with potential covid-19, to the recognition of cardiac arrest in children and basic life support (BLS) algorithm, foreign body airway obstruction, advanced life support (ALS), and the ethics of resuscitation in children during the covid-19 pandemic

Anxiety, hospital fears and conduct and behavioral alterations during pediatric hospitalization.

INTRODUCTION: A hospital admission is an experience capable of generating emotional and behavioral alterations at any age. This study pretends to analyze the response of anxiety, fears and/or behavioral alterations in pediatric patients exposed to a conventional non-surgical hospital admission and the existing relationship between these responses and certain modulating variables. Metodology. Design of cohorts. Data collection was carried out in three stages (M1: at admission; M2: at discharge; M3: 2 weeks after discharge), on a 30 patient sample between the ages of 6 to 15 years and 30 caregivers. A comparison was made on the mean of the repeated measurements (Student t) of the respond variables and their correlation (Pearson’s Coefficient Correlation) with modulating variables. RESULTS: The results of the intra-subject analysis showed significance in terms of anxiety levels state in patients in M1 versus M3 (t=3.93, p<.0001, d=0.69) and the magnitude of the total behavioral alterations registered in M1 versus M3 (t=-5.02, p<.0001, d=0.60). It was observed that a significant relationship between modulating variables of patients (anxiety risk) and of the caregiver (anxiety character state, strategy of confrontation) and the variables of response of the anxiety and behavioral alterations of the patient. CONCLUSIONS: Exposure of a conventional non-surgical hospital admission may have negative consequences at an emotional and behavioral level in children, present far beyond the hospital admission. Certain variables, from the patient and the caregiver, are psychological vulnerability factors before a hospitalization process.

Ansiedad, miedos hospitalarios y alteraciones conductuales en la hospitalización infantil / Anxiety, hospital fears and conduct and behavioral alterations during pediatric hospitalization

Introducción. El ingreso hospitalario es una experiencia susceptible de generar alteraciones emocionales o conductuales a cualquier edad. Este estudio pretende analizar la respuesta de ansiedad, miedos y/o alteraciones conductuales en pacientes pediátricos expuestos a un ingreso hospitalario convencional no quirúrgico y las relaciones existentes entre dichas respuestas y determinadas variables moduladoras. Metodología. Diseño de cohortes. La recogida de datos se realizó en tres momentos (M1: al ingreso; M2: al alta; M3: a las dos semanas del alta), sobre una muestra de 30 pacientes de 6 a 15 años y 30 cuidadores. Se realizó una comparación de medias de medidas repetidas (t de Student) de las variables de respuesta y su correlación (Coeficiente correlación de Pearson) con variables moduladoras. Resultados. Los resultados del análisis intrasujeto muestran significación en cuanto a los niveles de ansiedad estado del paciente en M1 versus M3 (t=3.93, p<0.0001, d=0.69) y la magnitud de alteraciones conductuales totales registradas en M1 versus M3 (t=-5.02, p<0.0001, d=0.60). Se objetivó relación significativa positiva entre variables moduladoras del paciente (ansiedad rasgo) y del cuidador (ansiedad rasgo-estado, estrategias de afrontamiento) y las variables de respuesta de ansiedad y alteraciones conductuales del paciente. Conclusiones. La exposición a una hospitalización convencional no quirúrgica puede producir consecuencias negativas a nivel emocional y conductual en el niño, presentes más allá del ingreso hospitalario. Determinadas variables, del paciente y del cuidador, son factores de vulnerabilidad psicológica ante el proceso de hospitalización

Introduction. A hospital admission is an experience capable of generating emotional and behavioral alterations at any age. This study pretends to analyze the response of anxiety, fears and/or behavioral alterations in pediatric patients exposed to a conventional non-surgical hospital admission and the existing relationship between these responses and certain modulating variables. Metodology. Design of cohorts. Data collection was carried out in three stages (M1: at admission; M2: at discharge; M3: 2 weeks after discharge), on a 30 patient sample between the ages of 6 to 15 years and 30 caregivers. A comparison was made on the mean of the repeated measurements (Student t) of the respond variables and their correlation (Pearson's Coefficient Correlation) with modulating variables. Results. The results of the intra-subject analysis showed significance in terms of anxiety levels state in patients in M1 versus M3 (t=3.93, p<.0001, d=0.69) and the magnitude of the total behavioral alterations registered in M1 versus M3 (t=-5.02, p<.0001, d=0.60). It was observed that a significant relationship between modulating variables of patients (anxiety risk) and of the caregiver (anxiety character state, constrategy of confrontation) and the variables of response of the anxiety and behavioral alterations of the patient. Conclusions. Exposure of a conventional non-surgical hospital admission may have negative consequences at an emotional and behavioral level in children, present far beyond the hospital admission. Certain variables, from the patient and the caregiver, are psychological vulnerability factors before a hospitalization process

El Comitè d’RCP de l’SCP i les recomanacions en ressuscitació 2015. Introducció / No disponible

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Suport vital en trauma 2015 / No disponible

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Primers auxilis 2015 / No disponible

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Formació en suport vital i implementació de les guies 2015 / No disponible

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Transició de les recomanacions en RCP pediàtrica i neonatal entre 2005 i 2015: guies 2010 / No disponible

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