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)

[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.

Réplica: Les fractures d'os llarg per maltractament són freqüentsen els menors de 2 anys / No disponible

No disponible

¿Son realmente infrecuentes las fracturas de hueso largo en menores de 2 años? / Are long bone fractures really rare in children younger than 2 years?

Introducción. Las fracturas son habituales entre las lesiones no intencionadas en la infancia, pero se cree que son poco frecuentes en lactantes. Objetivo. Determinar la frecuencia diagnóstica y las características de las fracturas producidas en niños menores de 2 años. Método. Estudio retrospectivo de las consultas de niños menores de 2 años diagnosticados de fractura de hueso largo en urgencias. Resultados. Se incluyen 258 consultas (prevalencia 0,2%), el 25,2% de niños menores de 1 año. Se diagnosticaron 293 fracturas (35 niños presentaban dos). El hueso más fracturado fue el radio (en menores de 1 año, el fémur), siendo en rodete el tipo más habitual. En 196 consultas (76%) se especifica la causa; las más frecuentes, caídas y golpes. El 15,1% de pacientes precisaron ingreso. Conclusiones. Las fracturas de hueso largo, aunque poco frecuentes en lactantes, presentan una morbilidad elevada. Es importante una anamnesis exhaustiva para esclarecer la causa y poder aplicar medidas preventivas (AU)

Introduction. Fractures are frequent events among the unintentional injuries of childhood; however, it is also believed that they are rare in preschool children. Objective. To determine the diagnostic frequency and the characteristics of fractures in children under two years of age. Method. Retrospective study of all children younger than two years diagnosed with a long bone fracture in the emergency department of a tertiary center during a 3-year period. Results. A total of 258 encounters (prevalence 0.2%) where a fracture was documented in a young child were included for the study; 25.2% of the children were younger than one year. 293 fractures were diagnosed (with 35 patients having two). The most frequent fractured bone was the radius (in less than one year olds was the femur), with the buckle fracture being the most common type. In 196 of the visits (76%) the cause was documented; the most common were falls and trauma. An admission was required in 15.1% of the patients. Comments. Long bone fractures, although uncommon in young children, have high morbidity rates. A thorough clinical history is important to establish the cause of the injury and to apply preventive measures (AU)