Cambios de los hábitos poblacionales en el tratamiento de la fiebre en la infancia / Change in habits among the population in the management of childhood fever

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[Infants aged 3-24 months with fever without source in the emergency room: characteristics, management and outcome]. / Lactante de 3-24 meses con fiebre sin foco en urgencias: características, tratamiento y evolución posterior.

OBJECTIVE: To determine the characteristics of infants aged 3-24 months admitted to a Hospital Pediatric Emergency Room with fever without source, the management of these infants and their subsequent outcome. PATIENTS AND METHOD: We performed a retrospective survey of 733 children aged 3-24 months with fever without source admitted to our Emergency Room between September 1, 2003 and December 31, 2003. Subsequently, the parents of all infants diagnosed with fever without source who were managed as outpatients were telephoned to ascertain their outcome and changes in the final diagnosis. RESULTS: Onset of fever occurred less than 6 hours before arrival at the hospital in 237 episodes (32.2%). The family reported a temperature of > or = 39 degrees C in 436 episodes. Diagnoses in the Emergency Room were the following: fever without source in 677 (92.3%), urinary tract infection in 53 (7.2%) and bacterial meningitis in three (0.4 %). Fifty-five infants with an altered dipstick were excluded and complete blood count (CBC) and blood culture were performed in 66 infants (9.7%). There was a significant negative association between the probability of a request for CBC and blood culture and higher age [6-11 months vs. 3-6 months OR 0.24 (95 % CI: 0.11-0.49); > or = 12 months vs. 3-6 months, OR 0.15 (0.07-0.3)] and a significant positive association with onset more than 12 hours previously [vs. less than 6 hours OR 2.3 (1.2-4.43)] and highest temperature registered at home > 40 degrees C [vs. less than 39 degrees C OR 4.22 (1.5-11.84)]. Follow-up was completed (by telephone or readmission to the Emergency Room) in 574 infants diagnosed with fever without source and managed as outpatients. The final diagnosis differed from that made in the Emergency Room in 158 infants (27.5%), and 70 received antibiotics (12.1%). CONCLUSIONS: A considerable percentage of infants aged 3-24 months with fever without source visits the Emergency Room with very short-term processes. Patient observation is very useful in the management of these infants, since the final diagnosis differed from that made in the emergency room in nearly 30% and 12% were treated with antibiotics.

Lactante de 3-24 meses con fiebre sin foco en urgencias: características, tratamiento y evolución posterior / Infants aged 3-24 months with fever without source inthe emergency room: characteristics, management and outcome

Objetivo: Conocer las características de los lactantes de 3-24 meses que consultaron en una unidad de urgencias pediátrica hospitalaria con fiebre sin focalidad, su tratamiento y evolución posterior. Pacientes y método: Estudio retrospectivo de los 733 episodios correspondientes a los lactantes de 3 a 24 meses que consultaron por fiebre sin focalidad entre el 1 de septiembre y el 31 de diciembre de 2003. Posteriormente se contactó telefónicamente con los diagnosticados de síndrome febril sin focalidad y tratados ambulatoriamente, para conocer su evolución y diagnóstico final. Resultados: El tiempo de evolución de la fiebre hasta la consulta fue inferior a 6 h en 237 episodios (32,2 %). En 436 casos la familia refirió una temperatura mayor o igual a 39 °C. Los diagnósticos fueron: síndrome febril sin focalidad, 677 (92,3 %); infección del tracto urinario, 53 (7,2 %), y meningitis bacteriana, 3 casos (0,4 %). Excluidos los 55 niños con tira reactiva de orina alterada, se practicó analítica sanguínea y hemocultivo a 66 (9,7 %). La probabilidad de solicitar analítica se asoció negativa y significativamente con: mayor edad (6-11 meses frente a 3-6 meses; odds ratio [OR], 0,24; intervalo de confianza [IC] del 95 %, 0,11-0,49; >= 12 meses frente a 3-6 meses; OR, 0,15 [límites, 0,07-0,3]); y positivamente con mayor tiempo de evolución superior a 12 h (frente a < 6 h; OR, 2,3 [límites, 1,2-4,43]); y temperatura máxima registrada en casa superior a 40 °C (frente a < 39 °C; OR, 4,22 [límites, 1,5-11,84]). En 574 niños diagnosticados de síndrome febril sin focalidad que siguieron tratamiento ambulatorio se completó el seguimiento (telefónicamente o por readmisión en urgencias), variando el diagnóstico en 158 (27,5 %), y recibieron antibiótico 70 (12,1 %). Conclusiones: Un porcentaje importante de lactantes de 3-24 meses con fiebre sin focalidad consulta por procesos muy recortados. La observación continuada es un instrumento capital del tratamiento de los lactantes con síndrome febril sin focalidad, ya que alrededor del 30 % reciben un diagnóstico final diferente al inicial y el 12 %, tratamiento antibiótico

Objective: To determine the characteristics of infants aged 3-24 months admitted to a Hospital Pediatric Emergency Room with fever without source, the management of these infants and their subsequent outcome. Patients and method: We performed a retrospective survey of 733 children aged 3-24 months with fever without source admitted to our Emergency Room between September 1, 2003 and December 31, 2003. Subsequently, the parents of all infants diagnosed with fever without source who were managed as outpatients were telephoned to ascertain their outcome and changes in the final diagnosis. Results: Onset of fever occurred less than 6 hours before arrival at the hospital in 237 episodes (32.2 %). The family reported a temperature of >= 39 °C in 436 episodes. Diagnoses in the Emergency Room were the following: fever without source in 677 (92.3 %), urinary tract infection in 53 (7.2%)and bacterial meningitis in three (0.4 %). Fifty-five infants with an altered dipstick were excluded and complete blood count (CBC) and blood culture were performed in 66 infants (9.7 %). There was a significant negative association between the probability of a request for CBC and blood culture and higher age [6-11 months vs. 3-6 months OR 0.24 (95 % CI: 0.11-0.49); >= 12 months vs. 3-6 months, OR 0.15 (0.07-0.3)] and a significant positive association with onset more than 12 hours previously [vs. less than 6 hours OR 2.3 (1.2-4.43)] and highest temperature registered at home > 40 °C [vs. less than 39 °C OR 4.22 (1.5-11.84)]. Follow-up was completed (by telephone or readmission to the Emergency Room) in 574 infants diagnosed with fever without source and managed as outpatients. The final diagnosis differed from that made in the Emergency Room in 158 infants (27.5 %), and 70 received antibiotics (12.1 %). Conclusions: A considerable percentage of infants aged 3-24 months with fever without source visits the Emergency Room with very short-term processes. Patient observation is very useful in the management of these infants, since the final diagnosis differed from that made in the emergency room in nearly 30 % and 12% were treated with antibiotics

Impacto de la intensificación del tratamiento en urgencias del niño con asma sobre la hospitalización / Consequences of strength treatment of children with asthma in a paediatric emergency department onto in-hospital admission

Objetivos: Estudiar el impacto de la intensificación del tratamiento de la crisis asmática en Urgencias sobre la hospitalización y reconsulta. Métodos: Estudio retrospectivo de los 12.288 episodios correspondientes a niños <14 años que consultan por crisis asmática en Urgencias entre 1-01-1998 y 31-12-2001 (epidemiología, tratamiento, destino y reconsulta -nueva visita por el mismo episodio en la semana siguiente). La intensificación del tratamiento en Urgencias se analiza en los 100 primeros pacientes atendidos en noviembre de 1998 y 2001.Resultados: De los 12.288 episodios, 1.292 requirieron permanecer un máximo de 24 horas en la Unidad de Observación (10,51 por ciento), 320 ingresó en planta (2,66 por ciento) y 36 en UCIP (0,29 por ciento). El tratamiento en Urgencias varió significativamente entre 1998 y 2001 (beta-2 inhalado 82 por ciento vs 96 por ciento, p=0,006; corticoide sistémico 31 por ciento vs 45 por ciento, p=0,04; bromuro de ipratropio inhalado 24 por ciento vs 39 por ciento, p=0,029). La media de dosis de beta-2 inhalado administrada pasó de 1,35ñ0,86 en 1998 a 1,68ñ0,86 en 2001, p=0,007. En 1998, el 8 por ciento de los niños recibió 3 ó más dosis de beta-2 (21 por ciento en 2001, p=0,015). Entre 1998 y 2001, disminuyó el porcentaje de niños que requirió permanecer en la Unidad de Observación (14,07 por ciento vs. 6,66 por ciento, p<0,00001), ingresar en planta (3,91 por ciento vs. 1,07 por ciento, p<0,00001), ingresar en UCIP (0,64 por ciento vs 0,07, p=0,0005) y la tasa de reconsulta (11,03 por ciento vs. 7,87 por ciento, p=0,0002).Conclusiones: La intensificación del tratamiento inicial de la crisis asmática en Urgencias se asocia con una disminución de las tasas de hospitalización, ingreso en UCIP y reconsulta (AU)