Acute Epstein-Barr virus infection: Diagnostic challenge in young children, risk factors for hospitalisation and cytomegalovirus co-detection.

AIM: Acute Epstein-Barr virus (aEBV) and cytomegalovirus (CMV) infections frequently have similar manifestations. We aim to evaluate the characteristics of aEBV infection, risk factors for hospitalisation and differences according to CMV IgM detection (EBV-CMV co-detection) in children. METHODS: Retrospective, single-centre study including patients <16 years diagnosed with aEBV infection (positive anti-EBV IgM/Paul-Bunnell test and acute symptomatology). EBV-CMV co-detection was defined as positive CMV IgM. Factors associated with age, hospitalisation and EBV-CMV co-detection were analysed in a multivariate analysis. RESULTS: A total of 149 patients were included (median age 4.6 years). Most frequent manifestations were fever (77%), cervical lymphadenopathy (64%) and elevated liver enzymes (54%). Younger children had lower rate of positive Paul-Bunnell test (35% vs. 87%; p < 0.01), but higher rate of EBV-CMV co-detection (54% vs. 29%; p = 0.03). These children tended to have less typical symptoms of infectious mononucleosis and higher hospitalisation rate. The overall antibiotic prescription was 49%. Hospitalisation (27 children; 18%) was independently associated with prior antibiotic therapy and anaemia. Sixty-two cases (42%) had EBV-CMV co-detection, which was independently associated with elevated liver enzymes and younger age. CONCLUSION: In this study, younger children with aEBV infection presented more frequently with atypical clinical symptoms, had higher EBV-CMV co-detection rates and were more often hospitalised. Hospitalisation was associated with prior antibiotic prescription.

Professionals' Perception of a Strategy to Avoid Interruptions During Medication Handling.

INTRODUCTION: The use of vests for handling medication (prescription, preparation, and dispensing) in the emergency department is a strategy designed to increase patient safety by reducing interruptions and, consequently, medication errors. In this study, we aim to assess how professionals perceive the use of vests in a pediatric emergency department of a tertiary hospital. MATERIAL AND METHODS: A cross-sectional survey was conducted among pediatric emergency physicians and nurses in October and November 2019. We analyzed the results of a 19-item survey on the perception of vests as a tool for reducing interruptions and medication errors. RESULTS: In this study, 91 surveys were delivered and 89 (97.8%) were completed. One hundred percent of the professionals were aware of the vests. Nurses reported the following reasons for not using the vest: high workload (25%) and preparation of nebulized and oral medications (25%). One hundred percent of doctors asked for the vest because of forgetfulness. Thirty-five physicians (81.4%) and 17 nurses (85.0%) said that wearing the vest, they were rarely or never interrupted. Eighty-two respondents (93.2%) agreed that vests are an effective strategy for minimizing medication errors. CONCLUSIONS: Although medical professionals consider vests to be a useful strategy to prevent interruptions and reduce medication errors, adherence to the protocol is low, so a promotion strategy is needed to encourage professionals to use the vests.

Acute Alcohol Intoxication in Pediatric Emergencies.

INTRODUCTION: Alcohol intoxication in pediatrics is a growing problem in our environment. The objectives of this study are to define the prevalence of acute alcohol intoxication in the pediatric emergency department (PED) and to describe the associated symptoms and their relationship with potential risk factors. METHODS AND MATERIAL: This cross-sectional study includes patients younger than 16 years with a diagnosis of acute alcohol intoxication between March 2010 and October 2018 in the PED of a tertiary hospital. Patients with concomitant intoxication by other substances were excluded. The association between qualitative variables was determined using the χ 2 or Fisher exact test and quantitative with the Student t , Mann-Whitney U test, and simple linear regression. RESULTS: There were 136 episodes of alcohol intoxication, which represents a prevalence of 24.1/100,000 emergencies. After excluding 10 patients because of positive screening for other drugs, 126 patients with a mean age of 14.5 years (SD, 1.2 years) were included, 57.9% of whom were women. A total of 25.4% of the patients were younger than 14 years. Ethanolemia was determined in 88.9%, and its mean concentration was 195.7 mg/dL (SD, 56.5 mg/dL), with potentially serious levels (>300 mg/dL) being found in 3.6% of the patients. A relationship was found between the Glasgow Coma Scale score and ethanolemia ( B = -12.7; 95% confidence interval, -8.1 to -17.4; P < 0.001), as well as with potassium ( B = -31, 9; 95% confidence interval, -6.6 to -57.3; P = 0.014). No patient had seizures or hypoglycemia. A total of 10.3% of the patients required admission. CONCLUSIONS: Alcohol intoxication is a rare consultation reason in the PED. They usually present with mild and self-limited symptoms, being the decrease in the level of consciousness and hypokalemia the most frequent symptom and analytical alteration.

Contamination in Urine Samples Collected Using Bladder Stimulation and Clean Catch Versus Urinary Catheterization in Infants Younger Than 90 Days.

OBJECTIVES: The objective of this study was to compare the risk of contamination for urine samples collected from patients younger than 90 days using 2 different techniques: bladder stimulation and "clean catch" (CC) and urinary catheterization (CATH). METHODS: A case-control study was carried out in the pediatric emergency room of a tertiary hospital between January 2016 and September 2017. All urine samples collected from patients younger than 90 days by CC or CATH were included. The incidence of contaminated urine samples was compared for both methods, and the risk of contamination was estimated using univariate and multivariate analyses. RESULTS: A total of 473 urine samples were collected, 310 via CATH (65.5%) and 163 via CC (34.5%). The median age was 1.4 months (interquartile range, 0.8-2.1 months), and 54.1% were males. Seventeen patients had a history of urinary tract infection (3.6%), and 16 were diagnosed with a congenital urorenal anomaly (3.4%). Sixteen urine samples were found to be contaminated (3.4%): 5 collected via CATH (1.6%) and 11 via CC (6.8%). The univariate analysis revealed a greater risk of contamination in specimens obtained using CC versus CATH (odds ratio, 4.41; 95% confidence interval, 1.51-12.93), and the multivariate analysis confirmed CC collection as an independent risk factor for contamination (odds ratio, 5.61; 95% confidence interval, 1.83-17.19). CONCLUSIONS: The number of contaminated urine samples in infants younger than 90 days in our pediatric emergency department is low. However, using the CC urine collection technique seems to be an independent risk factor for sample contamination.

Encuesta de satisfacción sobre atención hospitalaria tras el nacimiento y seguimiento al alta del recién nacido sano / Satisfaction survey on hospital care after birth and follow-up at discharge of the healthy newborn

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Briefings: A Tool to Improve Safety Culture in a Pediatric Emergency Room.

BACKGROUND: Safety briefings are short, informative meetings intended to integrate a culture of patient safety into daily clinical practice, which contributes to identifying risks and improving quality. The objective of this study is to present safety briefings as a method for discovering and addressing safety events in a pediatric emergency room, describe how professionals perceive them, and characterize the classification and evolution of the incidents identified. METHODS: This observational, descriptive, analytical study was performed in the pediatric emergency department of a tertiary hospital in 2018-2019. The incidents reported during the briefings were counted, classified, and analyzed. Results of a 10-item survey on the usefulness of the briefings in identifying and managing risks are described. RESULTS: A total of 498 briefings were analyzed, in which 1,180 incidents were reported (1 incident/96 emergency cases; 2.4 incidents/meeting). The category with the most incidents was Communication. The number of incidents fell by 24.4% between 2018 and 2019 (p < 0.01), mostly in the Identification (47.8%) and Communication (33.8%) categories. Seventy-seven surveys were analyzed. In 97.4% of the analyzed surveys, the person surveyed considered the briefings to be useful in improving patient safety; 90.9% considered notification via briefings to be more convenient than through electronic means. In 35.1%, the person surveyed was not satisfied with the information received on incident management. CONCLUSION: Patient safety briefings are perceived as a useful tool to report incidents, and incidents related to communication occur most frequently. Safety briefings are perceived as useful for improving patient safety in pediatric emergency rooms, and this method of notification is considered more convenient than other methods.

Hematoma subdural crónico en pacientes muy ancianos / Chronic subdural haematomas in very elderly patients

Introducción. El hematoma subdural crónico (HSC) es una patología frecuente en los servicios de neurocirugía, y especialmente prevalente entre los pacientes de edad avanzada. El objetivo de este estudio es analizar las características demográficas, clínicas y radiológicas en una serie de pacientes mayores de 85 años afectados de un HSC. Pacientes y métodos. Realizamos un estudio retrospectivo sobre una serie de pacientes mayores de 85 años entre abril de 1986 y noviembre de 2015. Se recogieron las características clínicas (edad, sexo, comorbilidades, factores de riesgo, características radiológicas) y los resultados quirúrgicos (complicaciones fundamentalmente centradas en las recidivas y mortalidad). Analizamos las particularidades de este grupo de edad y su relación entre edad, sexo, grado clínico, tratamiento antiagregante o anticoagulante, arquitectura del hematoma, desplazamiento de la línea media y número de trépanos realizados con la mortalidad y recidiva del hematoma. Resultados. Analizamos 200 pacientes con una edad media de 88,5 años (rango 85-104), con una relación varón:mujer de 1:1,1. Se recogió antecedente traumático en 114 casos (57%) y estaban sometidos a terapia anticoagulante o antiagregante 71 pacientes (35,5%). Al ingreso, 114 pacientes (57%) tenían un buen estado clínico (grado 0-2 de Markwalder). El principal síntoma fue el deterioro cognitivo en 82 casos (41%). El HSC estaba localizado en el hemisferio izquierdo en 89 (44,5%), derecho en 78 casos (39%) y bilateral en los restantes 33 (16,5%). Se presentaron 59 complicaciones en 59 casos (29 recidivas) y el grado clínico de Markwalder se relacionó con unos mayores índices de complicaciones y mortalidad (p<0,0001). Conclusiones. El HSC es una patología frecuente en los pacientes muy ancianos. Clínicamente se manifiesta con deterioro cognitivo y déficit neurológico. La situación clínica al ingreso representó en nuestra serie un importante factor predictivo tanto de complicaciones como de mortalidad (AU)

Introduction. Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. Patients and methods. A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. Results. A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). Conclusions. CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality (AU)

[Chronic subdural haematomas in very elderly patients]. / Hematoma subdural crónico en pacientes muy ancianos.

INTRODUCTION: Chronic subdural haematoma (CSDH) is one of the most common neurosurgical conditions and is especially prevalent among elderly individuals. The objective of this study was to analyse the demographic, clinical and radiological findings, and surgical outcomes in a series of chronic subdural haematoma in patients older than 85 years. PATIENTS AND METHODS: A review was carried out on all patients over 85 years with CSDH treated in our neurosurgical service from April 1986 to November 2015. A record was made of the baseline patient characteristics (age, sex, comorbidities, known risk factors, imaging characteristics, and number of burr-holes) and surgical outcomes (complications, especially recurrences and mortality). An analysis was carried out on the special characteristics of these patients, as well as the relationships between gender, clinical grade, anti-platelet or anticoagulant therapy, internal architecture of the haematoma, and midline shift, with mortality and recurrence of the haematoma. RESULTS: A total of 200 patients were included, with a mean age of 88.5 (range 85-104) years, and the male: female sex ratio was 1:1.1. History of injury was reported in 114 (57%) cases. Anti-platelet or anticoagulant therapy was being used by 71 (35.5%) patients. On admission, 114 patients (57%) were in satisfactory condition (Markwalder grades 0-2). The main symptom was behavioural disturbance in 82 (41%) cases. CSDH was left-sided in 89 (44.5%) patients, right-sided in 78 (39%) cases (39%), and bilateral in the remaining 33 (16.5%) cases). Postoperative complications were observed in 59 cases (29 recurrences). Preoperative Markwalder grade correlated significantly with recurrence rate and mortality (P<.0001). CONCLUSIONS: CSDH was a very common disease in very elderly patients. Behavioural disturbance and neurological deficits are the most common first symptom. Preoperative neurological status at admission is the most important factor in recurrences and mortality.