RESUMO
Temporary observation is a very short stay in Emergency Department, widely carried out in adult patients in our Country. No experience in childhood has been reported. In our emergency department children under 16 with acute diseases are admitted for 24-48 hours. From 1991 we carried out also temporary observation. Its effectiveness has been evaluated by studying our activity in 1992 (14.574 emergency room visits, with 664 admissions to our Department and 274 temporary observation) and 1993 (12820 emergency room visits, 573 admissions, 428 temporary observation). Compared to 1992, in 1993 there was a decrease of both emergency room visits (higher than expected from demographic lowering and in part due to payment for emergency room visits) and hospital admissions, and an increase of temporary observation. The stay in hospital was less than 6 hours in 94.2% of temporary observation patients. 18.2% of them were evaluated on clinical basis, 57% also by diagnostic examinations, 24.8% had some treatment. The 89% of the children were sent home following temporary observation, the others were admitted. Criteria for temporary observation were fairly similar to those for hospital admission, but not far as Central Nervous System and Renal Disease are concerned. Our study confirms the usefulness of temporary observation in childhood to reduce both the number of hospital admissions and the discomfort of the patient and his family. Nevertheless there is a need of criteria of appropriateness. Therefore we have elaborated guide lines for temporary observation and admission to our Department.
Assuntos
Serviços Médicos de Emergência/estatística & dados numéricos , Hospitalização , Tempo de Internação , Criança , Proteção da Criança , Pré-Escolar , Hospitais Pediátricos , Humanos , Lactente , Itália , Admissão do Paciente , Estudos RetrospectivosRESUMO
OBJECTIVE: To evaluate the safety and the immunogenicity of a booster dose of recombinant acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTaP, Biocine SpA) in 15- to 21-month-old children primed in infancy with either whole-cell diphtheria-tetanus-pertussis (DTwP) vaccine or DTaP vaccine. DESIGN: Open-label second phase of a double-masked, controlled trail, with masked analysis of serum samples. PARTICIPANTS AND SETTING: Three hundred fifty children, 15 to 21 months of age, who had been primed at 2, 4, and 6 months of age with either three doses of DTaP vaccine (n = 173) or DTwP vaccine (n = 177). The children were enrolled in eight vaccination centers in Italy. INTERVENTIONS: All children received a booster dose of the DTaP vaccine and were examined for safety at 48 hours and at 7 days after vaccination. Serum samples for evaluation of immunogenicity were obtained from 196 (55%) of the 350 children. MAIN OUTCOME MEASURES: IgG antibodies to pertussis toxin (Ptox), filamentous hemagglutinin, 69-kilodalton protein, and tetanus toxoid were measured by enzyme-linked immunosorbent assay. Pertussis toxin-neutralizing antibodies were measured by the Chinese hamster ovary cell toxin neutralization assay. MAIN RESULTS: Adverse reactions to DTaP were infrequent, and there was no difference in the incidence of local or systemic reactions in children given DTaP as a fourth dose in comparison with a first dose. One month after the DTaP booster vaccination, both groups had 6- to 40-fold increases in serum antibody concentrations to all antigens tested; the concentrations against the three pertussis antigens were higher in the DTaP-primed children (p < 0.05). The antibody titers to diphtheria and tetanus toxoids were higher in the DTwP-primed group (p < 0.05), but both groups had protective titers. The geometric mean ratio of anti-Ptox neutralizing antibody per unit of IgG anti-Ptox antibody was higher in the DTaP-primed group (p < 0.001). CONCLUSIONS: There are quantitative and qualitative differences in booster responses to DTaP vaccine in young children, depending on whether they were given DTaP or DTwP as primary immunization. This DTaP vaccine is safe and highly immunogenic as a booster.
Assuntos
Bordetella pertussis/imunologia , Vacina contra Difteria, Tétano e Coqueluche , Imunização Secundária , Toxina Pertussis , Vacina contra Coqueluche , Fatores de Virulência de Bordetella , Coqueluche/prevenção & controle , Anticorpos Antibacterianos/biossíntese , Vacina contra Difteria, Tétano e Coqueluche/efeitos adversos , Vacina contra Difteria, Tétano e Coqueluche/imunologia , Método Duplo-Cego , Ensaio de Imunoadsorção Enzimática , Seguimentos , Humanos , Lactente , Vacina contra Coqueluche/efeitos adversos , Vacina contra Coqueluche/imunologia , Fatores de Tempo , Vacinas Sintéticas/efeitos adversos , Vacinas Sintéticas/imunologiaRESUMO
Utilization of the pediatric Emergency Room has been evaluated during the year 1991, by a questionnaire study on 694 children. By comparison with a previous research in 1981 it was possible to identify a further decrease of urgent and appropriate visits with increase of those inappropriate. Visits were more frequently urgent of appropriate in case of acute health problems, inappropriate if related to recurrent problems. Without considering true emergencies, three main causes for ER consultation have been identified: family custom, inappropriate relationships with the practitioner, dependence on the hospital. In the first group of children most of the visits proved inappropriate. The study points out a further increase of inappropriate utilization of ER, due mainly to inappropriate relationships between the family and the practitioner. This has to be corrected to reduce costs and improve child care.
Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Pediatria/normas , Adulto , Atitude Frente a Saúde , Criança , Proteção da Criança , Pré-Escolar , Atenção à Saúde/normas , Serviço Hospitalar de Emergência/normas , Família , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Lactente , Itália , Masculino , Relações Médico-PacienteRESUMO
Costs and benefits of the repair in Emergency Room of skin lacerations by tissue adhesive in children are reported. In 1987-88 2150 children under 16 were referred to our Institute because of lacerations. About one of three of them needed repair by subcutaneous suture; in the others, sutures or sterile stripes or adhesive tissue could be employed. Adhesive tissue use increased significantly during 1988 because of its advantages: no need of local anesthesia, syringes, sterile suture instruments and dressing materials; no further dressing; no suffering of children during the treatment; good aesthetic results. Now it is the first choice treatment of the lacerations in which subcutaneous suture is not necessary. Moreover this technique is cheap, and reduced significantly 1988 costs for laceration repair in our department.
Assuntos
Adesivos Teciduais/administração & dosagem , Ferimentos e Lesões/cirurgia , Adolescente , Fatores Etários , Criança , Análise Custo-Benefício , Embucrilato/administração & dosagem , Humanos , SuturasRESUMO
Four infants with congenital heart disease showed in their first months of life poor weight gain in spite of the absence of cardiac failure; a diagnosis of intolerance to cow's milk proteins was made on the basis of laboratory findings and subsequently confirmed by the success of the avoidance diet and the positivity of the challenge tests; all four children had previously received nasogastric feeding, and this may represent a favouring factor for sensitization. Intolerance to cow's milk proteins should be considered as a possible cofactor for failure to thrive in infants with congenital heart disease.
Assuntos
Insuficiência de Crescimento/etiologia , Cardiopatias Congênitas/complicações , Leite/efeitos adversos , Animais , Bovinos , Feminino , Humanos , Lactente , Alimentos Infantis , Recém-Nascido , Síndromes de Malabsorção/etiologia , Masculino , Proteínas do Leite/efeitos adversosRESUMO
The authors describe the application of a technique called Patient Flow Analysis aimed at the improvement of Clinic Personnel efficiency and reduction of patient waiting time. Results were satisfactory and encourage further experiences.