Caídas en menores de un año: ¿qué hacemos en urgencias? / Falls in less than one year-old infants: Management in the emergency department

Objetivos: Describir y analizar las lesiones asociadas a caídas en los menores de un año, la actuación durante su atención en urgencias, los medios empleados en su manejo y los factores que condicionan un mayor uso de los mismos. Material y métodos: Estudio multicéntrico, descriptivo y analítico. Se incluyeron los menores de un año que habían acudido por caídas al servicio de urgencias de 8 hospitales integrantes del Grupo de Trabajo de Lesiones no Intencionadas de la Sociedad Española de Urgencias Pediátricas. Se recogieron datos sobre las circunstancias previas a la llegada a urgencias, las lesiones observadas, la actuación en urgencias y los medios empleados durante su manejo. Resultados: Se identificaron 1.022 pacientes, un 0,35% de las urgencias atendidas (IC 95%: 0,348-0,352). La localización más frecuente del traumatismo fue craneal (58%). La indicación de radiografía de cráneo (31,8%) se relacionó con hematomas o signos de fractura en la exploración física (p < 0,001), alturas mayores de 100cm (p < 0,001) y edad menor de 3 meses (p = 0,004). Tras el traumatismo craneal leve (85,6%), las fracturas fueron el diagnóstico más frecuente, fundamentalmente craneales (7,1%), asociándose con una edad menor de 3 meses (p < 0,001) y con la existencia de hematoma o signos de fractura en la exploración física (p < 0,001). Un 6% de los casos requirieron hospitalización, identificándose la edad menor a 3 meses y una caída mayor a 50 cm como factores de riesgo. Conclusiones: Las lesiones por caídas en los menores de un año se producen fundamentalmente por traumatismos craneales y siguen constituyendo una indicación frecuente de realización de pruebas complementarias (AU)

Objectives: A study was performed in order to describe injuries associated with falls in children aged <1 year who attended the emergency department. The approaches used were examined, as well as the factors associated with the greater use of these approaches, and the management of the patient. Patients and methods: This was a multicentre, descriptive and analytical study that included all patients aged <1 year who had experienced a fall for which they attended the emergency departments of one of 8 Spanish Hospitals belonging to the "Unintentional Paediatric Injury Working Group" of the Spanish Paediatric Society. A record was made of the data regarding the visit, circumstances before arrival at the hospital, injuries observed, and the diagnostic and therapeutic approaches used. Results: A total of 1022 patients had experienced falls, that is, 0.35% of the emergencies attended in the study hospitals (95% CI, 0,348-0,352). The most commonly affected part was the head (58%). Cranial radiography was ordered in 31.8% of cases, and was associated with the presence of bruising or signs of fracture on examination (P < .001), falls from heights > 100cm (P < .001), and age < 3 months (P = .004). Minor head injury was the most common finding (85.6%), followed by fractures, especially cranial fractures (7.1%), which were associated with bruising or signs of fracture on examination (P < .001), and age < 3 months (P < .001). Six percent of the patients required admission to hospital. The risk factors for hospital admission in this group were falls from heights >50 cm and age < 3 months. Conclusions: Injuries after falls in infants aged < 1 year are commonly due to head trauma and frequently require additional diagnostic tests (AU)

Epidemiología y factores de riesgo de las lesiones por caídas en niños menores de un año / Epidemiology and risk factors in injuries due to fall in infants under one year-old

Objetivos: Describir las características epidemiológicas de las caídas en menores de un año y analizar los factores de riesgo asociados a las lesiones de mayor gravedad. Pacientes y métodos: Estudio multicéntrico, observacional y transversal, de los niños menores de un año que acudieron por caídas a las Urgencias de 8 hospitales del territorio nacional, pertenecientes al Grupo de Trabajo de Lesiones No Intencionadas de la Sociedad Española de Urgencias de Pediatría, entre el 1 de marzo de 2014 y el 28 de febrero de 2015. Resultados: De un total de 289.887 consultas, 1.022 correspondieron a caídas en menores de un año. La mediana de edad fue de 8 meses y el 52,5% fueron varones. Las lesiones por caídas fueron más frecuentes entre los 9 y los 12 meses (37,6%) y en el 83,5% el lugar de caída fue el domicilio habitual. Hasta un 69,4% sufrieron la caída desde dispositivos infantiles y desde una altura inferior a 50cm el 47,8%. En un 68% las caídas fueron presenciadas; sin embargo, en la mitad de los casos (329) el cuidador no se encontraba en el área de alcance. Un 12% de las lesiones fueron graves. En la muestra se identificaron la altura de la caída mayor a 50cm, las caídas en la vía pública, desde los brazos del cuidador y desde las escaleras como factores de gravedad independientes. Conclusiones: Las lesiones más graves se producen en niños <3 meses y desde una altura de >50cm, sin embargo, no se relacionan con caídas no presenciadas. Debido a que el mecanismo más frecuente en las lesiones graves es la caída desde los brazos del cuidador, desde las escaleras y en la vía pública, debemos alertar sobre este hecho para evitar la morbilidad asociada (AU)

Objectives: To describe the epidemiological characteristics of unintentional injuries due to falls in children under one year and to analyse the risk factors associated with severe injuries. Patients and methods: This multicentre, observational and cross-sectional study included all children less than one year treated for unintentional fall in the Emergency Departments of 8 Spanish Hospitals, belonging to the «Unintentional Paediatric Injury Workshop» of the Spanish Paediatric Emergency Society, between March 1st, 2014 and February 28th, 2015. Results: Out of 289,887 emergency department cases, 1,022 were due to unintentional falls. The median age was 8 months and 52.5% were males. Fall injuries were more frequent among children aged 9-12 months (37.6%), and 83.5% occurred at home. The most common mechanism was fall from nursery equipment (69.4%), and 47.8% occurred from a height under 50cm. More than two-thirds (68%) of falls were witnessed, but in half of the cases (329) the caregiver was not in area. Serious injuries were seen in 12% of cases. In this study, a fall height greater than 50cm, falls in the street, from the arms of the carer, and from the stairs were identified as independent risk factors for worse outcomes. Conclusions: The most serious injuries occur in children <3 months and from a height of >50cm, though not related to unwitnessed falls. Because the most common serious injury mechanism is the fall from the arms of the carer, from stairs, and falls in the street, these facts should be highlighted in order to avoid morbidity (AU)

[Epidemiology and risk factors in injuries due to fall in infants under one year-old]. / Epidemiología y factores de riesgo de las lesiones por caídas en niños menores de un año.

OBJECTIVES: To describe the epidemiological characteristics of unintentional injuries due to falls in children under one year and to analyse the risk factors associated with severe injuries. PATIENTS AND METHODS: This multicentre, observational and cross-sectional study included all children less than one year treated for unintentional fall in the Emergency Departments of 8 Spanish Hospitals, belonging to the «Unintentional Paediatric Injury Workshop¼ of the Spanish Paediatric Emergency Society, between March 1st, 2014 and February 28th, 2015. RESULTS: Out of 289,887 emergency department cases, 1,022 were due to unintentional falls. The median age was 8 months and 52.5% were males. Fall injuries were more frequent among children aged 9-12 months (37.6%), and 83.5% occurred at home. The most common mechanism was fall from nursery equipment (69.4%), and 47.8% occurred from a height under 50cm. More than two-thirds (68%) of falls were witnessed, but in half of the cases (329) the caregiver was not in area. Serious injuries were seen in 12% of cases. In this study, a fall height greater than 50cm, falls in the street, from the arms of the carer, and from the stairs were identified as independent risk factors for worse outcomes. CONCLUSIONS: The most serious injuries occur in children <3 months and from a height of >50cm, though not related to unwitnessed falls. Because the most common serious injury mechanism is the fall from the arms of the carer, from stairs, and falls in the street, these facts should be highlighted in order to avoid morbidity.

[Falls in less than one year-old infants: Management in the emergency department]. / Caídas en menores de un año: ¿qué hacemos en urgencias?

OBJECTIVES: A study was performed in order to describe injuries associated with falls in children aged <1 year who attended the emergency department. The approaches used were examined, as well as the factors associated with the greater use of these approaches, and the management of the patient. PATIENTS AND METHODS: This was a multicentre, descriptive and analytical study that included all patients aged <1 year who had experienced a fall for which they attended the emergency departments of one of 8 Spanish Hospitals belonging to the "Unintentional Paediatric Injury Working Group" of the Spanish Paediatric Society. A record was made of the data regarding the visit, circumstances before arrival at the hospital, injuries observed, and the diagnostic and therapeutic approaches used. RESULTS: A total of 1022 patients had experienced falls, that is, 0.35% of the emergencies attended in the study hospitals (95% CI, 0,348-0,352). The most commonly affected part was the head (58%). Cranial radiography was ordered in 31.8% of cases, and was associated with the presence of bruising or signs of fracture on examination (P<.001), falls from heights >100cm (P<.001), and age <3 months (P=.004). Minor head injury was the most common finding (85.6%), followed by fractures, especially cranial fractures (7.1%), which were associated with bruising or signs of fracture on examination (P<.001), and age <3 months (P<.001). Six percent of the patients required admission to hospital. The risk factors for hospital admission in this group were falls from heights >50cm and age <3 months. CONCLUSIONS: Injuries after falls in infants aged <1 year are commonly due to head trauma and frequently require additional diagnostic tests.

Diffuse persistent pulmonary interstitial emphysema secondary to mechanical ventilation in bronchiolitis.

BACKGROUND: Persistent interstitial pulmonary emphysema (PIE) is a rare disease and it is even more uncommon in full-term infants, like our patient. When conservative management is not successful, surgical treatment should be considered. In our case, ECMO support was iniciated to keep the patient ventilated in order to allow the lung to heal using lung protection strategies. CASE PRESENTATION: We report an 18-day-old male infant with bronchiolitis that required mechanical ventilation with high positive airway pressures due to severe respiratory insufficiency. Chest X-rays and computed tomography scan revealed a severely hyperinflated left lung with extensive destructive changes and multiple small bullae. These findings were consistent with diffuse persistent interstitial emphysema (PIE), probably due to mechanical ventilation. The patient required high frequency oscillatory ventilation, inotropic support and continuous renal replacement therapy. He eventually suffered a cardiac arrest that required cardiopulmonary resuscitation and ECMO during 5 days with progressive clinical improvement and normalization of the X-ray. CONCLUSION: We present a patient with diffuse persistent interstitial emphysema who, despite an unfavorable evolution with different mechanical ventilation strategies, had a good response after ECMO assistance.