Análisis de las derivaciones a la Atención Especializada desde la consulta de Atención Primaria / Analysis of referrals to Specialized Care from Primary Care

Introducción: la derivación a una consulta especializada forma parte de la práctica diaria en Atención Primaria. La cuantificación y valoración de los motivos de derivación plantean una reflexión sobre los recursos humanos y materiales de los que disponemos, y sobre si los circuitos de relación entre los diferentes niveles asistenciales son los más adecuados para los pacientes y los profesionales. Objetivo: determinar, a partir de las derivaciones realizadas desde un equipo de Pediatría de Atención Primaria, los servicios a los que se derivan más pacientes y los motivos de las derivaciones. Material y métodos: estudio descriptivo transversal de las derivaciones realizadas a la Atención Especializada desde los centros de salud de Vallirana y Cervelló (Barcelona), con una población de 3375 niños de0 a 14 años, a partir del registro de la historia clínica informatizada, durante los años 2007, 2008 y 2009. Resultados: en este periodo se han realizado 1460 derivaciones en una población atendida de 3375 menores de 15 años de edad. Se presentan los resultados del análisis de 1422 derivaciones, ya que de las restantes no disponemos de todos los datos. La especialidad a la que se han derivado más casos es Oftalmología (27,65%), seguida de Traumatología (16,88%), Dermatología (14,84%) y Otorrinolaringología (12,52%). Conclusiones: las especialidades más demandadas son Oftalmología, Traumatología, Dermatología y Otorrinolaringología. Estas especialidades son una constante en cada grupo de edad. Los resultados obtenidos podrían ser de ayuda para planificar la relación entre los diferentes niveles asistenciales (AU)

Introduction: children referral to specialized consultation is part of the Primary Care daily work. Quantification and evaluation of the referral reasons make us think about the human and material resources available and also consider if the relationship between the different care levels are the best for patients as well as for health staff. Objective: to determine which are the specialist areas that receive more referrals from the Primary Care pediatric team and their motives. Material and methods: transversal descriptive study of the specialized care referrals made by the Vallirana’s and Cervello’s Primary Care pediatricians. Vallirana and Cervelló villages (Barcelona) have 3375 children younger than 15 years old. Data were obtained from the electronic medical record between 2007 and 2009. Results: during this three years period, 1460 referrals have been done for 3375 children younger than 15 years old attended in the Primary care centres. Thirty-eight of them haven’t been analysed because of lack of complete information. Ophthalmology is the most referred specialization (27.65%) followed by Orthopaedics (16.88%), Dermatology (14.84%) and Otolaryngology (12.52%) as the more required specializations. Conclusions: Ophthalmology, Orthopaedics, Dermatology and Otolaryngology are the most referred specialities. These specialities are constant in each year group. These results could help to organize the relationship between the different care levels (AU)

[Congenital diaphragmatic hernia: evaluation of two ways of management]. / Hernia diafragmática congénita: análisis de dos formas de tratamiento.

OBJECTIVE: The aim of this study was to analyze the treatment and evolution of congenital diaphragmatic hernia in the last 16 years, distinguishing two ways of management, and to look for parameters that can predict the evolution. MATERIALS AND METHODS: Between 1978 and 1994, 29 cases of congenital diaphragmatic hernia were treated in our NICU. During the first period (1978-1988) 17 cases (group 1) were treated after birth as a surgical emergency. In the second period (1989-1994), preoperative stabilization was performed before surgery (12 cases, group 2). Two cases of group 2 were excluded because of the association of other malformations that were the cause of death. RESULTS: Both groups were similar in gestational age, birth weight and Apgar score at 5 minutes. Overall mortality was 48.1% (47.0% in group 1 and 50.0% in group 2). No infants with PaCO2 greater than 40 mmHg and OI greater than 40 or VEI over 1,000 survived. CONCLUSION: Despite preoperative stabilization, there is no difference in the mortality rate of the two groups. With congenital diaphragmatic hernia, as with other entities of low incidence, collaborative studies are needed to obtain enough cases to analyze the results more precisely.

[Routes of endotracheal colonization in patients with mechanical ventilation]. / Rutas de colonización traqueal en pacientes sometidos a ventilación mecánica.

OBJECTIVE: We prospectively evaluated the frequency and route of endotracheal colonization in intubated children in order to know what microorganisms, either by primary infection or through previous colonization of oropharynx and/or stomach and progression towards the lower respiratory tract, are responsible for these infections. PATIENTS AND METHODS: Oropharyngeal, tracheal and gastric samples of 43 patients were collected for culture at the moment of intubation and at 24-h intervals for 4 days. The colonization route for each endotracheal microorganism was classified depending on the initial isolation site. Isolated microorganisms were considered as belonging to the same strain if the biochemical pattern and antibiogram were identical. RESULTS: Of the patients studied, 84% presented positive cultures the first day. Tracheal colonization was detected at day 1 in 22 patients (51%) and in 35 (82%) at the end of the study. A colonization sequence was seen in 18 patients (41%). The microorganisms most frequently isolated were S. aureus, P. aeuruginosa and C. albicans. CONCLUSIONS: The mechanisms of tracheal colonization in intubated children is similar to adults. Oropharynx colonization is the key antecedent. Prophylaxis measures should avoid the proliferation at the oropharyngeal and/or gastric level.

[Acute ethmoiditis. A review of 38 cases]. / Etmoiditis aguda. Revisión de 38 casos.

OBJECTIVE: The purpose of this study was to assess the usefulness of computerized tomography (CT) scan in the diagnosis and management of the complications of acute ethmoiditis in children. MATERIALS AND METHODS: A retrospective revision of the records of pediatric patients admitted to Sant Joan de Déu Hospital from January 1985 to June 1994 was performed. RESULTS: Thirty-eight children (22 males and 16 females) between the ages of 18 months and 15 years (mean age 6.5 years) were studied. All of the patients had eyelid afflictions; 5 (13.2%) with eyelid edema and 33 (86.8%) with periorbital cellulitis. All of them were unilateral without side predominance. The signs and symptoms included fever (37) and orbital pain and headache (24), with 28 patients presenting other forms of sinusitis. CT scan was applied in 24 children (63%). Thirteen of these patients demonstrated complications of the orbit, 6 with orbital cellulitis, 4 subperiosteal abscess and 3 orbital abscesses. Surgery was performed in 3 cases. CONCLUSIONS: We conclude that the CT scan is a radiological procedure that must be applied when there are signs or symptoms compatible with orbital complications. Patients should also be scanned if their exam is worse or unchanged after 24-48 hours of antibiotic therapy. Early diagnosis and antibiotic treatment can prevent complications subsidiary of surgery.