Respiratory diseases in pediatric triage: a comparison between a general emergency department and a pediatric emergency department.

OBJECTIVE: In this study, the authors have compared data concerning the pediatric triage that is carried out in 2 large emergency departments (EDs) in Rome, one located in a university pediatric clinic with qualified staff and the other one in a general hospital with a high flow of users and pediatric admissions. METHODS: A total of 324 children were selected (162 per hospital) with ages between 0 and 3 years who went to the ED in the period from October to December 2009 for respiratory pathologic findings at the lower respiratory tracts' expense. We took and compared the following data: assignation of the color code, congruity of the color code, and realization of the reevaluation. DISCUSSION: This study reveals several differences between the 2 structures considered with a clear tendency of nurses of the general ED to underestimate color codes, giving undertriage rates in a significant number of cases. Another significantly important difference was found on the detection of children's vital parameters. One last important parameter that emerged from this study was the lack of attention to the reevaluation of the patient after admission in ED. RESULTS: In the light of what we pointed out, it is necessary to implement the educational and informative quality of the triage operators and educators, planning periodical triage training courses to reduce errors. Particular emphasis must be placed on providing pediatric continuing education for nurses practicing in general ED.

Pollen-induced allergic rhinitis in 1360 Italian children: comorbidities and determinants of severity.

BACKGROUND: Pollen-induced allergic rhinoconjunctivitis (AR) is highly prevalent and rapidly evolving during childhood. General practitioners may not be fully aware of the nature and severity of symptoms experienced by patients and might underestimate the prevalence of moderate or severe disease. Thus, the relevance of early diagnosis and intervention may be overlooked. OBJECTIVES: To investigate the severity of pollen-induced AR and its determinants in Italian children referred to allergy specialists and who had never received specific immunotherapy (SIT). METHODS: Children (age 4-18 yr) affected by pollen-induced AR who had never undergone SIT were recruited between May 2009 and June 2011 in 16 pediatric outpatient clinics in 14 Italian cities. Recruited children's parents answered standardized questionnaires on atopic diseases (International Study of Allergy and Asthma in Childhood, Allergic Rhinitis and its Impact on Asthma, Global Initiative for Asthma). The children underwent skin-prick test (SPT) with several airborne allergens and six food allergens. Information on socio-demographic factors, parental history of allergic diseases, education, perinatal events, breastfeeding, nutrition and environmental exposure in early life was collected through an informatics platform shared by the whole network of clinical centers (AllergyCARD™). RESULTS: Among the 1360 recruited patients (68% males, age 10.5 ± 3.4 yr), 695 (51%) had moderate-to-severe AR, 533 (39%) asthma, and 325 (23.9%) oral allergy syndrome (OAS). Reported onset of pollen-induced AR was on average at 5.3 ± 2.8 yr, and its mean duration from onset was 5.2 ± 3.3 yr. Only 6.2% of the patients were pollen-monosensitized, and 84.9% were sensitized to ≥3 pollens. A longer AR duration was significantly associated with moderate-to-severe AR symptoms (p 0.004), asthma (p 0.030), and OAS comorbidities (p < 0.001). CONCLUSIONS: This nationwide study may raise awareness of the severity of pollen-induced AR among Italian children who have never received pollen SIT. The strong association between pollen-induced AR duration and several markers of disease severity needs replication in longitudinal studies, while suggesting that countrywide initiatives for earlier diagnosis and intervention should be planned.

[Congenital heart diseases in women]. / Le cardiopatie congenite nel sesso femminile.

Are there gender differences in prevalence, surgical results and long-term survival of patients with congenital heart disease? Available literature data allow us to state what follows. At birth there is a mild but significant prevalence of congenital heart disease in females. The most severe congenital heart diseases are less frequent in girls, but when they are present in females, they are linked to a higher surgical mortality rate, due perhaps to lower weight at birth and to the prevalence of extracardiac malformations and/or of associated genetic syndromes. On the other hand, in adults, surgery for congenital heart disease is at higher risk in males, and so the long-term survival rate is higher in females. Particular psychological attitudes, a higher incidence of pulmonary hypertension, as well as specific problems linked to the reproductive function characterize congenital heart disease in adult women. The knowledge and analysis of these data are essential for a correct management of congenital heart disease in neonates, children and adults.