Estudio retrospectivo de los pacientes con diagnóstico confirmado de tosferina que son atendidos en urgencias de un hospital de tercer nivel / Retrospective study of patients with a confirmed diagnosis of whooping cough treated in the emergency room of a tertiary hospital

INTRODUCCIÓN: se analizan las características clínicas, pruebas complementarias y tratamientos recibidos por los pacientes con diagnóstico de tosferina que son valorados en Urgencias de Pediatría. MATERIAL Y MÉTODOS: estudio descriptivo retrospectivo de los casos de tosferina que consultaron en Urgencias de Pediatría de un hospital de tercer nivel entre marzo de 2014 y octubre de 2017. RESULTADOS: se analizaron 89 casos (55% mujeres) con edad media de 1,67 ± 2,9 años. El 98,9% presentó tos, el 33% gallo inspiratorio y el 34,8% apneas. En el 64% de los casos había entorno epidémico de tos o tosferina. La media de visitas en urgencias durante el mismo proceso fue 1,4. Diagnósticos más frecuentes en la primera visita a urgencias: tos (36%), sospecha de tosferina (22,5%), infección respiratoria de vías altas (19,1%) y bronquiolitis (9%). Ingresaron 56 pacientes (62,9%), con una edad media de 0,38 ± 1,2 años. Se realizó cultivo para Bordetella en 88 casos (positivo para B. pertussis en 38 y B. parapertussis en tres) y reacción en cadena de la polimerasa en 73 (positivo para B. pertussis en 70 y B. parapertussis en tres). CONCLUSIONES: el diagnóstico de tosferina habitualmente es difícil, ya que la sintomatología inicialmente es inespecífica. El diagnóstico precoz es fundamental para iniciar un tratamiento inmediato y realizar una adecuada profilaxis de contactos

INTRODUCTION: the aim of the study was to analyse the clinical characteristics, diagnostic tests performed and treatment used in patients with pertussis evaluated in the paediatric emergency setting. MATERIAL AND METHODS: we conducted a retrospective descriptive study of patients with pertussis that sought care in the paediatric emergency department of a tertiary care hospital between March 2014 and October 2017. RESULTS: the sample included 89 patients with a mean age of 1.67 ± 2.9 years. Of the total, 98.9% presented with cough, 33% with inspiratory whoop and 34.8% with apnoea. Sixty-four percent of cases occurred in the context of an epidemic of cough or pertussis. The mean number of emergency visits made during a single episode of disease was 1.4. The most frequent diagnoses in the initial emergency visit were cough (36%), suspected pertussis (22.5%), upper respiratory tract infection (19.1%) and bronchiolitis (9%). Fifty-six patients were admitted to hospital (62.9%) with a mean age of 0.38 ± 1.2 years. Cultures for detection of Bordetella were performed in 88 cases (positive for B. pertussis in 38 and B. parapertussis in 3), and PCR tests in 73 (positive for B. pertussis in 70 and B. parapertussis in 3). CONCLUSIONS: the diagnosis of pertussis is usually challenging, as its initial symptoms are nonspecific. Early diagnosis is essential for early initiation of treatment and adequate contact prophylaxis

Escabiosis: lesiones pruriginosas altamente contagiosas / Scabies: highly contagious pruritic lesions

La escabiosis es una infestación producida por Sarcoptes scabiei, caracterizada por lesiones generalizadas pruriginosas. El diagnóstico es eminentemente clínico. Síntomas compatibles en varios miembros de la misma familia se consideran diagnósticos. El tratamiento consiste en la aplicación de Permetrina al 5% en la superficie cutánea.

Scabies is an infestation produced by Sarcoptes scabiei. Itchy generalized lesions characterized this pathology. The diagnosis is clinical. Compatible symptons presented in some members of the same family are considered diagnostic. The treatment is based in the application of Permetrine 5% in all the cutaneous area.

Evaluation and Impact of the "Advanced Pediatric Life Support" Course in the Care of Pediatric Emergencies in Spain.

INTRODUCTION: The Advanced Pediatric Life Support (APLS) course was introduced in the training of professionals who care for pediatric emergencies in Spain in 2005. OBJECTIVE: To analyze the impact of the APLS course in the current clinical practice in Spanish PEDs. METHODS: The directors of APLS courses were asked about information regarding the courses given to date, especially on the results of the satisfaction survey completed by students at the end of the course. Furthermore, in December 2014, a survey was conducted through Google Drive, specifically asking APLS students about the usefulness of the APLS course in their current clinical practice. RESULTS: In the last 10 years since the APLS course was introduced in Spain, there have been 40 courses in 6 different venues. They involved a total of 1520 students, of whom 958 (63.0%) felt that the course was very useful for daily clinical practice. The survey was sent to 1,200 students and answered by 402 (33.5%). The respondent group most represented was pediatricians, 223 (55.5%), of whom 61 (27.3%) were pediatric emergency physicians, followed by pediatric residents, 122 (30.3%). One hundred three (25.6%) respondents had more than 10 years of professional practice and 291 (72.4%) had completed the course in the preceding four years. Three hundred forty-one of the respondents (84.9%: 95% confidence interval [CI], 81.9-87.9) said that they always use the pediatric assessment triangle (PAT) and 131 (32.6%: 95% CI, 28-37.1) reported that their organization has introduced this tool into their protocols. Two hundred twenty-three (55.5%: 95% CI, 50.6-60.3) believed that management of critically ill patients has improved, 328 (81.6%: 95% CI, 77.8-85.3) said that the PAT and the systematic approach, ABCDE, help to establish a diagnosis, and 315 (78.4%: 95% CI, 74.3-82.4) reported that the overall number of treatments has increased but that these treatments are beneficial for patients. Hospital professionals (191; 47.5%) include the PAT in their protocols more frequently than pre-hospital professionals (68.5% vs 55.4%; p <0.01) and consider PAT useful in the management of patients (60.2% vs 51.1%; p <0.05). Neither the time elapsed since the completion of the course, nor category and years of professional experience had any influence on the views expressed about the impact of the APLS course in clinical practice. CONCLUSIONS: Most health professionals who have received the APLS course, especially those working in the hospital setting, think that the application of the systematic methods learned, the PAT and ABCDE, has a major impact on clinical practice.

Reconsultas en una unidad de urgencias pediátricas / Return visits to a paediatric emergency department

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Pediatricians' attitudes and costs of bronchiolitis in the emergency department: a prospective multicentre study.

BACKGROUND: How pediatricians manage bronchiolitis and the derived total costs (direct and indirect) in the emergency department (ED) have not been fully characterized. The aim of the present study is to calculate those costs in a European country. METHODS: A prospective and observational study, including 10 EDs of tertiary hospitals throughout Spain and during the bronchiolitis season 2010-2011, was performed. Every ED recruited children on random days of the week (3 days per week; always including one non-working day per every week). Recruitment aimed at a total sample size of 600 children. Direct (diagnostic procedures, time spent in the ED and medication) and indirect costs (work hours lost by parents, babysitting, travels, and meals) were collected. Comparisons between bronchiolitis caused by respiratory syncytial virus (RSV) and non-RSV bronchiolitis, as well as costs across severity categories were performed with the Kruskal-Wallis test. A multiple regression model was built to assess the influence of several of the studied factors on the total costs, including a RSV positive test and episode severity as independent variables; and gender, age, attending nursery school, preterm birth, low birth weight, smoker mother during pregnancy, and current smoker father as covariates. RESULTS: From the 664 recruited children, direct mean costs were €213.2 ± 91.8 and indirect ones were €35.9 ± 55.3; the total costs being €249.2 ± 122.9. Costs were significantly higher in children positive to RSV and rose with increased severity. Those associations were maintained in the multiple regression analysis. CONCLUSIONS: Although relatively low at the individual level (€249.2, mean total cost) the costs for just the ED expenses of bronchiolitis in Spain would add up to about €20 million per year.

Autoevaluación del cumplimiento del protocolo de manejo del traumatismo craneoencefálico en niños menores de 1 año en urgencias / No disponible

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Aproximación etiológica a la hipoglucemia en urgencias: revisión de un protocolo / No disponible

No disponible