Peripheral trauma treated in the pediatric emergency department: Descriptive study. / Traumatismos periféricos atendidos en el Servicio de Urgencias Pediátricas. Estudio descriptivo.

INTRODUCTION: Peripheral trauma is a very frequent cause of consultation in paediatric emergency departments but few studies have been published describing the characteristics of these patients. MATERIAL AND METHODS: We performed a retrospective descriptive study by reviewing computerised emergency department forms during January and February 2020. OBJECTIVE: To describe the characteristics of traumatic injuries in our area and to detect possible areas for improvement. RESULTS: A total of 714 peripheral trauma cases were attended, which represents 9.5% of the total consultations. A total of 52.7% were schoolchildren (6-11 years). The most frequent locations were the ankle (27.5%) and fingers (17.2%). Fracture was detected in 6.7% of cases. Radiographs were requested in 78.6% of the patients, with pathological findings in 9.6% of them. Half of the X-rays were requested due to ankle or finger trauma. Referral to traumatology was made in 16.4% of patients, mainly for elbow and knee trauma, and the most commonly used treatment was general measures (49%) and bandaging (29.4%). CONCLUSIONS: Peripheral trauma is very common and, in general, banal. A large number of X-rays are requested with a very low yield, so it seems necessary to establish new protocols to reduce the number of requests. Improving training in elbow and knee trauma could improve paediatricians' autonomy in dealing with these more complex injuries.

Síndrome anticolinérgico por dexclorfeniramina como causa de retención urinaria / Anticholinergic syndrome due to dexchlorpheniramine as a cause of urinary retention

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Hemoptisis leve en un niño inmigrante. Puesta al día diagnóstica / Mild emoptysis immigrant child: Diagnostic up-date

Presentamos el caso de un varón de 9 años de edad, de origen peruano, con antecedentes de tos crónica y expectoración hemoptoica discontinua de tres meses de evolución en el que se detecta un infiltrado pulmonar persistente en la radiografía de tórax. Describimos la norma de actuación con este tipo de pacientes así como la problemática creada en la detección de la causa subyacente del sangrado. La hemoptisis es un signo infrecuente en la práctica pediátrica pero muy angustiante para el paciente y su familia, así como para el médico, para quién supone un reto diagnóstico-terapéutico. Su baja incidencia e n el niño puede llevar a retrasos iniciales en su diagnóstico e incluso a que este signo pase inadvertido. El espectro de entidades patológicas que pueden causarla es muy amplio y habitualmente las más frecuentes son las causas infecciosas, aunque también pueden subyacer otras enfermedades potencialmente graves. Por ello es prioritario conocer su etiología exacta y decidir la consiguiente actitud terapéutica (AU)

We present the case of a 9 year-old child form Peru with a background of chronic cough and discontinuous hemotoxic expectoration of 3 months evolution in which persistent pulmonary infiltrate was detected don the chest x-ray. We describe the action guidelines with this type of patients as well as the problems created in the detection of the underlying cause of bleeding. Hemoptysis is an uncommon sign in the pediatric practice, however it produces much anxiety for the patient and their family, as well as for the physician, for whom it supposes a diagnostic-therapeutic challenge. Its low incidence in the child may lead to initial delays in its diagnosis and this sign may even go unnoticed. The spectrum of pathological conditions that may cause it is very wide and usually the most frequent ones are infectious causes, although there may be other underlying potentially severe diseases. Therefore, it is of priority to know the exact etiology and t decide the consequent therapeutic attitude (AU)

Evolución de la prescripción de antibióticos en un servicio de urgencias pediátricas / Evolution of the antibiotics prescription in a pediatric emergency service

Objetivo: Describir la calidad de prescripción antibiótica en un servicio de urgencias pediátrico, antes y después de la realización de dos sesiones formativas sobre el «uso racional de antibióticos». Material y métodos: Estudio descriptivo y retrospectivo de los pacientes dados de alta en urgencias durante el mes de enero de 2008, respecto a diciembre de 2008-enero de 2009. Se recogieron los datos sociodemográficos y relacionados con el diagnóstico y el tratamiento de los pacientes que recibían tratamiento antimicrobiano. Se valoró la posología y la indicación según las vías clínicas validadas de nuestro hospital. Entre ambos periodos, se impartieron dos sesiones formativas sobre el uso racional de antibióticos. Resultados: En enero de 2008 se revisaron 5.989 informes de alta, y se pautaron antibióticos al 13% de los niños. En el segundo periodo se revisaron 6.359 informes, y recibieron antibióticos un 12,7%. Los diagnósticos más frecuentes fueron la faringoamigdalitis aguda (49,6%) en el primer periodo y la otitis media (39%) en el segundo. La indicación fue correcta en el 90,7%en el primer periodo, frente al 84,7% en el segundo (p <0,01), la dosificación fue adecuada en el 79,4 frente al 86% (p <0,01), y la duración fue correcta en el 88,6% en ambos periodos. Se prescribieron más antibióticos durante el turno de noche y en días festivos. Conclusiones: El porcentaje de antibióticos prescritos es similar al de otras series. Tras las sesiones formativas sobre el manejo correcto de la antibioterapia, no ha disminuido su prescripción. Aunque se dosifica mejor, ha aumentado el porcentaje de indicación incorrecta. Serían necesarias más medidas para mejorar la calidad de prescripción antimicrobiana (AU)

Objective: To describe the quality of antibiotic prescription in the pediatric emergency service before and after two educational talks regarding “the rational use of antibiotics”. Material and methods: Descriptive, retrospective study of all the discharged patients evaluated in the emergency service during the month of January 2008 compared to December 2008 and January 2009. Demographic, social, diagnostic and treatment parameters of children who received antimicrobials treatment were analyzed. Dosage and indication were evaluated according to the validated clinical guidelines of the hospital, between both periods’ formative sessions about the rational use of antibiotics. Results: In January 2008 we reviewed 5,989 medical discharge records and found that 13% of the children had received antibiotics. We also reviewed 6,359 records from the second period and found that 12.7% of the children had received antibiotic therapy. The most frequent diagnoses were acute pharyngotonsillitis (49.6%) in the first period and acute otitis media (39%) in the second period. The indication and dosage were correct in 90.7% and 79.4% of the cases in the first period compared to 84.7% and 86% in the second period (p <0.01) respectively. The duration of therapy was correct in 88.6% of cases in both periods. Antibiotics were more frequently prescribed at the night shift and on holidays. Conclusions: The percentage of antibiotic prescription in this study is similar to that of other series and did not decrease after educational talks regarding the rational use of antibiotics. Although there was an increase in the correct dosage prescribed the percentage of incorrect antibiotic indications increased as well. Further actions should be taken to improve the quality of antibiotic prescriptions (AU)

Atelectasia en niños: ¿qué es lo que parece estar detrás? / Atelectasis in children: what appears to be the cause?

Presentamos un caso de tuberculosis pulmonar en una niña de 15 meses de edad enviada a nuestra consulta para efectuar un estudio de su neumonía recurrente. La radiografía de tórax pone de manifiesto una condensación localizada en el lóbulo medio, con signos sugestivos de atelectasia. La atelectasia es un problema común en los pacientes pediátricos, generalmente secundaria a una obstrucción bronquial por tapones de moco. Se analizan los tipos de atelectasia y sus causas más comunes, y se insiste en la utilidad de ciertas técnicas consideradas agresivas, como la fibrobroncoscopia, que en realidad son pruebas sencillas y con una gran validez diagnóstica y terapéutica. El manejo de las atelectasias depende de la causa subyacente. Es primordial tratar de forma conjunta la enfermedad de base y el colapso pulmonar, y en la mayoría de los casos es suficiente mantener una actitud conservadora (AU)

We report on a case of pulmonary tuberculosis in a fifteen month-old girl who was referred to our practice for tests following recurrent pneumonia. The chest X-ray showed localized condensation in the middle lobe with signs suggestive of atelectasis. Atelectasis is a common problem in paediatric patients, and tends to be secondary to bronchial obstruction due to mucus plugs. We analyse the types of atelectasis and their most common causes. Moreover, we stress the usefulness of certain techniques that are considered to be aggressive, like the fibrobronchoscopy, but which in reality are simple tests with a high level of diagnostic and therapeutic productivity. The approach to atelectases depends on the underlying cause, and it is essential to treat both the underlying disease as well as the collapsed lung; in most cases, a conservative approach is sufficient (AU)

Control nutricional en pacientes de traumatología / Nutritional control in orthopedic surgery patients

Objetivos: Establecer la incidencia y evolución de malnutrición en una cohorte de pacientes ingresados en un servicio de traumatología. Ámbito: Es un estudio observacional y prospectivo, realizado en un hospital terciario que dispone de Unidad de Nutrición Clínica. Pacientes: Se estudian 107 pacientes (56,1% mujeres, 43,9% hombres, edad 62,1 ± 20,4 años) al ingreso en el Servicio de Traumatología y la evolución en la primera consulta externa de los pacientes intervenidos para colocar una prótesis de cadera o rodilla. Intervenciones: Se realizó una historia clínica, recogida de datos antropométricos y tres tests de cribado nutricional: Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Valoración Global Subjetiva (VGS). Con ellos se calcula la prevalencia de malnutrición al ingreso, comparando las diferencias entre los métodos y la posible existencia de asociación entre la malnutrición y otros factores, tales como úlceras por presión o dependencia para las actividades de la vida diaria. Resultados: Según el MNA el 22% tiene riesgo de malnutrición, en la VGS es un 24% (un 4% están malnutridos) y en el MUST un 80% presenta alto riesgo de malnutrición. Un 1,7% de los pacientes tienen un Índice de Masa Corporal (IMC) menor que 18,5. Existe una relación significativa entre la malnutrición y estado neuropsicológico (p = 0,001), dependencia para las actividades de la vida diaria (p = 0,002) y entre el MUST de alto y medio riesgo con la aparición de úlceras por presión (p = 0,003). Hay empeoramiento del estado nutricional postquirúrgico con 2 tests: MNA y VGS (p = 0,000). Conclusión: En las condiciones del estudio la prevalencia de malnutrición al ingreso en el Servicio de Traumatología es elevada, los pacientes con cirugía protésica de rodilla y cadera muestran al mes un claro empeoramiento de su estado nutricional, así como una mayor incidencia de úlceras por presión (AU

Objective: To assess the nutritional status of orthopaedic patients. Design: Prospective observation study. Setting: Tertiary hospital, Clinical Nutrition Unit. Patients: 107 patients (56,1% women, 43,9% men, 62,1± 20,4 years) are studied at admission to the orthopaedic unit and it is observed the evolution of orthopaedic surgery patients with hip or knee prosthesis. Material and methods: Medical history, anthropometric data and three nutritional screening tools were considered: Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Valoración Global Subjetiva (VGS). It was assessed the prevalence of malnutrition in patients on admission to hospital, using different methods and determining if a correlation exists between malnutrition and other factors, such as the development of pressure sores of the dependence in activities of daily living. Results: The risk of malnutrition is 22 and 24/100 patients admitted at hospital, if MNA and SGA are used, respectively (SGA caregorized 4% of the group as "malnourished"). 80% patients are considered to be at high risk of malnutrition using MUST. 1,7% patients presented a Body Mass Index (BMI) lower than 18,5. There is a strong agreement between malnutrition and neropsychological status (p = 0,001), and the dependence in activities of daily living (p = 0,002), and between medium and high risk of malnutrition and the development of pressure sores (p = 0,003). If MNA and SGA (p = 0,000) are used, post-surgical patients presents a deteriorating nutritional status. Conclusions: The prevalence of malnutrition in patients on admission to hospital is elevated. Orthopaedic surgery patients with hip and knee prosthesis presented a deteriorating nutritional status, and a higher incidence of pressure sores in a month (AU)

[Nutritional control in orthopedic surgery patients]. / Control nutricional en pacientes de traumatología.

OBJECTIVE: To assess the nutritional status of orthopaedic patients. DESIGN: Prospective observation study. SETTING: Tertiary hospital, Clinical Nutrition Unit. PATIENTS: 107 patients (56.1% women, 43.9% men, 62.1 +/- 20.4 years) are studied at admission to the orthopaedic unit and it is observed the evolution of orthopaedic surgery patients with hip or knee prosthesis. MATERIAL AND METHODS: Medical history, anthropometric data and three nutritional screening tools were considered: Mini-Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST) y Valoración Global Subjetiva (VGS). It was assessed the prevalence of malnutrition in patients on admission to hospital, using different methods and determining if a correlation exists between malnutrition and other factors, such as the development of pressure sores of the dependence in activities of daily living. RESULTS: The risk of malnutrition is 22 and 24/100 patients admitted at hospital, if MNA and SGA are used, respectively (SGA caregorized 4% of the group as "malnourished"). 80% patients are considered to be at high risk of malnutrition using MUST. 1.7% patients presented a Body Mass Index (BMI) lower than 18.5. There is a strong agreement between malnutrition and neropsychological status (p = 0.001), and the dependence in activities of daily living (p = 0.002), and between medium and high risk of malnutrition and the development of pressure sores (p = 0.003). If MNA and SGA (p = 0.000) are used, post-surgical patients presents a deteriorating nutritional status. CONCLUSIONS: The prevalence of malnutrition in patients on admission to hospital is elevated. Orthopaedic surgery patients with hip and knee prosthesis presented a deteriorating nutritional status, and a higher incidence of pressure sores in a month.