Sedoanalgesia With Ketamine in the Emergency Department: Factors Associated With Unsatisfactory Effectiveness.

OBJECTIVE: Ketamine is a safe and widely used sedative and analgesic in children. The purpose of this study is to evaluate the response to sedoanalgesia for painful procedures in the pediatric emergency department. METHODS: A retrospective study was conducted in children younger than 16 years who underwent painful procedures with intravenous/intranasal ketamine between January 2016 and December 2022. We collected demographic variables, effectiveness, route of administration, indication, dose, sedation strategy, duration of procedure, and associated adverse effects. RESULTS: A total of 671 ketamine sedation procedures (411 males/260 females) were included, with a mean age of 7.2 years. Closed reduction was the most common painful procedure (53.8%), followed by burn healing (24.6%). Ketamine was administered intravenously in 93.4% of procedures and intranasally in 6.6%. The result of sedoanalgesia was satisfactory in 84.9% and unsatisfactory in 15.1%. The percentage of cases with unsatisfactory analgesia was higher with intranasal administration (36.4%; P < 0.001). In the intravenous group, the percentage of cases with unsatisfactory effectiveness (28.7%) was higher for patients younger than 2 years of age (P < 0.001). Arthrocentesis procedures were associated with the highest percentage of unsatisfactory sedoanalgesia failures among patients receiving intravenous ketamine (39.3%; P < 0.001). Intranasal ketamine patients who received a dose between 3.6 and 4 mg/kg had a significantly higher percentage of unsatisfactory sedoanalgesia (66.7%; P = 0.048). Patients receiving intravenous ketamine had significantly higher rates of unsatisfactory sedoanalgesia when the initial dose interval was 1.6 to 2 mg/kg (11.8%; P = 0.002) and when the final total dose was also 1.6 to 2 mg/kg (17.6%; P = 0.002). CONCLUSIONS: This study concludes that intravenous/intranasal ketamine can provide safe and successful analgesia in pediatric patients in the ED. At intravenous doses of 1-1.5 mg/kg, good effectiveness was achieved in almost 90% of cases. Arthrocentesis had the highest percentage of unsatisfactory results. Repeat dosing should be considered for procedures longer than 20 minutes.

Retrospective study of acute mastoiditis in children in Spain attended in a Pediatric Emergency department.

OBJECTIVE: To analyze the cases of acute mastoiditis, characteristics, management and complications in children attended in the emergency department. METHODS: Retrospective study of acute mastoiditis in a Spanish tertiary hospital over a 6-year period (2018-2023). RESULTS: One hundred two episodes of acute mastoiditis were analyzed (54% males, median age 1.8 years). Microorganisms were isolated in one third of cases, mainly Streptococcus pyogenes (64% of ear secretion cultures). Complications occurred in 27.5%, primarily subperiosteal abscess. A younger age, absence of vaccination schedule, previous history of otitis, cochlear implant carriers or white blood cell counts and C-reactive protein levels were not associated with complications. Complicated cases had longer hospitalizations. Treatment included antibiotics, corticosteroids, and surgery in 50% of cases. CONCLUSIONS: This study shows an increase of acute mastoiditis during 2023, with a relevant role of S. pyogenes. A younger age, absence of vaccination, personal history of otitis or cochlear implant, blood cell counts and C-reactive protein levels were not associated with complications.

Clinical characterization of pediatric acute confusional migraine: a single-center case series.

INTRODUCTION: Acute confusional migraine (ACM) is a rare disorder characteristic of pediatric patients. Our objective was to describe the clinical characteristics of patients diagnosed with ACM who visited our pediatric emergency department (PED). METHODS: This study was a retrospective review of children who presented to our PED between January 2012 and December 2022 with a discharge diagnosis of ACM. RESULTS: During the study period, 23 patients were enrolled: 11 males (47.8%) and 12 females (52.2%); median age was 10.8 years (IQR: 8.3-13.6). Eight patients reported a history of headache. The median length of stay of PED was 4.7 h. Onset was abrupt (less than 12 h) in 100% of cases. Changes in the level and content of consciousness occurred in 47.8% and 91.3% of patients, respectively; confusion (73.9%) was the most common neurological manifestation. Eighteen patients had urgent brain CT scans, none showing pathological findings. Four patients required benzodiazepines to control their psychomotor agitation. Nine patients were hospitalized, including one in the intensive care unit. Two patients underwent MRI and one patient underwent EEG during hospitalization, with normal results. DISCUSSION: ACM is a rare condition in pediatric neurology characterized by acute onset of confusion or altered mental status before, during, or after migraine headache. Clinical features overlap with other neurological disorders, making diagnosis challenging. To improve the diagnosis, treatment, and research of AMC, it is essential to include it in the International Classification of Headache Disorders and establish standardized diagnostic criteria.

Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence.

INTRODUCTION: Group A Streptococcus (GAS) causes mild diseases, and unfrequently invasive infections (iGAS). Following the December 2022 alert from the United Kingdom regarding the unusual increase in GAS and iGAS infections, we analyzed the incidence of GAS infections in 2018-2022 in our hospital. METHODS: We conducted a retrospective study of patients seen in a pediatric emergency department (ED) diagnosed with streptococcal pharyngitis and scarlet fever and patients admitted for iGAS during last 5 years. RESULTS: The incidence of GAS infections was 6.43 and 12.38/1000 ED visits in 2018 and 2019, respectively. During the COVID-19 pandemic the figures were 5.33 and 2.14/1000 ED visits in 2020 and 2021, respectively, and increased to 10.2/1000 ED visits in 2022. The differences observed were not statistically significant (p=0.352). CONCLUSIONS: In our series, as in other countries, GAS infections decreased during the COVID-19 pandemic, and mild and severe cases increased considerably in 2022, but did not reach similar levels to those detected in other countries.

Emergency department evaluation of transplanted children with COVID-19.

BACKGROUND: Children usually have an asymptomatic or mild course of SARS-CoV-2 infection, studies in immunocompromised patients have shown a different evolution. The aim of this study was to describe the clinical, laboratory, and radiologic manifestations of pediatric solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) patients testing positive for SARS-CoV-2. METHODS: A multicenter retrospective, observational descriptive study was conducted in 3 tertiary hospitals in Madrid (Spain) between March 2020 and December 2022. Consecutive patients aged 0-18 attending the corresponding pediatric emergency departments with a positive result in the real-time polymerase chain reaction test or antigenic test to detect SARS-CoV-2 in the nasopharyngeal sample were included. RESULTS: A total of 31 children were included in the study. Sixteen (51.6%) were patients with HSCT and 15 (48.3) were patients with SOT. The median time from transplantation to COVID-19 was 1.2 years (IQR:0.5-5.1). The SOT cohort included liver (n = 4, 12.9%), kidney (n = 4, 12.9%), heart (n = 3, 9.7%), multivisceral (n = 3, 9.7%), and lung (n = 1, 3.2%). Of the 31 patients, only one was asymptomatic. The most common symptom on presentation was fever (76.7%). Abnormalities were seen on chest X-ray in 8 (66.6%) of the 12 patients. There was no significant difference in clinical manifestations, lymphopenia and radiological findings regardless of the type of transplantation or immunosuppression status. Thirteen patients (41.9%) were hospitalized. There were no patient deaths. CONCLUSIONS: In our study, we found that the clinical course and outcome of SOT and HSCT pediatric patients with COVID-19 were generally favorable.

[Influencia de la pandemia de la COVID-19 en la distribución de la bronquiolitis aguda en España.] / Influencia de la pandemia de la COVID-19 en la distribución de la bronquiolitis aguda en España.

OBJECTIVE: Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Since the onset of the SARS-CoV-2 coronavirus disease pandemic (COVID-19), there has been a change in the transmission of other respiratory viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country. METHODS: We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging to four autonomous communities. A chi-square test and Student's t- test were used to compare epidemiological and demographic variables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital in the previous three years (2018-2020). RESULTS: We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, we observed a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSV infection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions). CONCLUSIONS: The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distribution of the disease are not uniform. It starts in the center of Spain and ends on the coast.

OBJETIVO: La bronquiolitis es la primera causa de hospitalización en menores de un año, presentándose en forma de epidemias anuales. Desde el inicio de la pandemia por la enfermedad causada por el coronavirus SARS-CoV-2 (COVID-19) se ha producido un cambio en la transmisión de otros virus respiratorios. Nuestro objetivo en este trabajo fue describir cómo había afectado la pandemia de la COVID-19 a la distribución de la bronquiolitis aguda en nuestro país. METODOS: Realizamos un estudio descriptivo retrospectivo de los casos de bronquiolitis atendidos en una muestra de hospitales españoles que pertenecían a cuatro comunidades autónomas. Empleado el test chi-cuadrado y la prueba t de Student comparamos variables epidemiológicas y demográficas de los casos de bronquiolitis atendidos durante enero de 2021 y junio 2021, con los tres años anteriores (2018-2020). RESULTADOS: Analizamos 6.124 casos de bronquiolitis (58,8% varones y 41,2% mujeres). La media de edad fue de 0,5 años (DE: 0,4). En 2020 observamos un descenso de casos de bronquiolitis con respecto a 2019 del 67%. Durante 2020 y 2021 la temporada epidémica empezó en enero-febrero y alcanzó su pico máximo en junio. Durante el primer semestre de 2021, el porcentaje más elevado de ingresos por bronquiolitis asociados a infección VRS fue observado en hospitales del centro de España correspondientes a la Comunidad Autónoma de Madrid (78,5% de los ingresos). CONCLUSIONES: La pandemia por la COVID-19 modifica de manera significativa la estacionalidad de la bronquiolitis. En nuestro país, el flujo y distribución de la enfermedad no es uniforme, comenzado por el centro peninsular y, por último, la zona litoral.

Influencia de la pandemia dela COVID-19 en la distribución de la bronquiolitis aguda en España / Influence of the pandemic of COVID-19 in distribution of acute bronchiolitis in Spain

Fundamentos: La bronquiolitis es la primera causa de hospitalización en menores de un año, presentándose en forma de epidemias anuales. Desde el inicio de la pandemia por la enfermedad causada por el coronavirus SARS-CoV-2 (COVID-19) se ha producido un cambio en la transmisión de otros virus respiratorios. Nuestro objetivo en este trabajo fue describir cómo había afectado la pandemia de la COVID-19 a la distribución de la bronquiolitis aguda en nuestro país. Métodos: Realizamos un estudio descriptivo retrospectivo de los casos de bronquiolitis atendidos en una muestra de hospitales españoles que pertenecían a cuatro comunidades autónomas. Empleado el test chi-cuadrado y la pruebat de Student comparamos variables epidemiológicas y demográficas de los casos de bronquiolitis atendidos durante enero de 2021 y junio 2021, con los tres años anteriores (2018-2020). Resultados: Analizamos 6.124 casos de bronquiolitis (58,8% varones y 41,2% mujeres). La media de edad fue de 0,5 años (DE: 0,4). En 2020 observamos un descenso de casos de bronquiolitis con respecto a 2019 del 67%. Durante 2020 y 2021 la temporada epidémica empezó en enero-febrero y alcanzó su pico máximo en junio. Durante el primer semestre de 2021, el porcentaje más elevado de ingresos por bronquiolitis asociados a infección VRS fue observado en hospitales del centro de España correspondientes a la Comunidad Autónoma de Madrid (78,5% de los ingresos). Conclusiones: La pandemia por la COVID-19 modifica de manera significativa la estacionalidad de la bronquiolitis. En nuestro país, el flujo y distribución de la enfermedad no es uniforme, comenzado por el centro peninsular y, por último, la zona litoral.(AU)

Background: Bronchiolitis is the leading cause of hospitalization in children under one year of age, with annual epidemics. Sincethe onset of the SARS-CoV-2 coronavirus disease pandemic (COVID-19), there has been a change in the transmission of other respiratory viruses. Our aim in this paper was to describe how COVID-19 had affected the distribution of acute bronchiolitis in our country. Methods: We conducted a retrospective descriptive study of the cases of bronchiolitis treated in a sample of Spanish hospitals belonging to four autonomous communities. A chi-square test and Student’s t- test were used to compare epidemiological and demographicvariables between patients attending the hospital with bronchiolitis during January 2021-June 2021 with patients attending the hospital in the previous three years (2018-2020). Results: We analyzed 6,124 cases of bronchiolitis (58.8% males and 41.2% females). The mean age was 0.5 years (SD: 0.4). In 2020, weobserved a decrease of bronchiolitis cases compared to 2019 of 67%. During 2020 and 2021, the epidemic season started in January-February and peaked in June. During the first half of 2021, the highest percentage of admissions for bronchiolitis associated with RSVinfection was observed in hospitals in central Spain corresponding to the Autonomous Community of Madrid (78.5% of admissions).Conclusions: The COVID-19 pandemic significantly modifies the seasonality of bronchiolitis. In our country, the flow and distri-bution of the disease are not uniform. It starts in the center of Spain and ends on the coast.(AU)

Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence / Infecciones por Streptococcus pyogenesen en niños españoles antes y después de la pandemia de COVID. Volviendo a la incidencia previa

Introduction: Group A Streptococcus (GAS) causes mild diseases, and unfrequently invasive infections (iGAS). Following the December 2022 alert from the United Kingdom regarding the unusual increase in GAS and iGAS infections, we analyzed the incidence of GAS infections in 2018–2022 in our hospital. Methods: We conducted a retrospective study of patients seen in a pediatric emergency department (ED) diagnosed with streptococcal pharyngitis and scarlet fever and patients admitted for iGAS during last 5 years. Results: The incidence of GAS infections was 6.43 and 12.38/1000 ED visits in 2018 and 2019, respectively. During the COVID-19 pandemic the figures were 5.33 and 2.14/1000 ED visits in 2020 and 2021, respectively, and increased to 10.2/1000 ED visits in 2022. The differences observed were not statistically significant (p=0.352). Conclusions: In our series, as in other countries, GAS infections decreased during the COVID-19 pandemic, and mild and severe cases increased considerably in 2022, but did not reach similar levels to those detected in other countries.(AU)

Introducción: Streptococcus del grupo A (GAS) causa infecciones leves y ocasionalmente invasivas (iGAS). Tras la alerta publicada en diciembre de 2022 en el Reino Unido respecto al aumento de infecciones por GAS leves e iGAS, analizamos la incidencia de estas infecciones en 2018-2022 en nuestro hospital. Métodos: Realizamos un estudio retrospectivo de los niños atendidos en urgencias pediátricas (UP) diagnosticados de faringitis estreptocócica y escarlatina y los ingresados por iGAS durante 5 años. Resultados: La incidencia de infecciones por GAS fue de 6,43 y de 12,38/1.000 visitas a UP en 2018 y 2019, respectivamente. Durante la pandemia fue de 5,33 y de 2,14/1.000 visitas en 2020 y 2021, respectivamente, y aumentó a 10,2/1.000 visitas en 2022. Estas diferencias no fueron estadísticamente significativas (p=0,352). Discusión: En nuestra serie, al igual que en otros países, las infecciones por GAS disminuyeron durante la pandemia de COVID-19, pero en 2022 aumentaron considerablemente los casos leves y graves, sin alcanzar cifras similares a las detectadas en otros países.(AU)

Amoxicillin overdose in the pediatric emergency department: A descriptive study.

OBJECTIVE: To describe the characteristics of pediatric patients treated in the  emergency department due to amoxicillin overdosing. METHOD: A retrospective single-center observational study was conducted on  patients aged 0 to 16 years treated in a pediatric emergency department due  to amoxicillin overdosing between 2011 and 2021. Epidemiological and  anthropometric data was collected as well as information on the circumstances  of overdosing, clinical manifestations, emergency department management,  and discharge destination. RESULTS: The study comprised 15 patients, 66.6% of them male, with a median age of 3.8 years (interquartile range: 1.9). The most frequent cause  of overdosing was accidental ingestion (8/15; 53.3%). Amoxicillin was mainly ingested in liquid form, except for one case with autolytic attempt,  where it was ingested in the form of tablets. Eighty percent of subjects (12/15) received a single dose of the drug. The median time to presentation to  emergency department was 2.1 hours from ingestion (interquartile range: 2.7) and the median dose of amoxicillin was 219 mg/kg/dose (interquartile range:  148). All patients were asymptomatic, with a normal physical examination.  Blood tests were performed in 7 patients (46.6%) and urinary sediment  analysis in 2 (13.3%), all of them without alterations. Activated charcoal was  administered to 5 (33.3%), patients with a median time to administration of  one hour (interquartile range: 1.2). All patients were discharged to their  homes. Eleven cases (73.3%) required withdrawal of amoxicillin. CONCLUSIONS: Amoxicillin overdosing in this study did not appear to result in  adverse effects, despite the fact that the recommended doses were  significantly exceeded.

OBJETIVO: Describir las características de los pacientes pediátricos atendidos en urgencias por sobreingesta de amoxicilina.Método: Estudio unicéntrico observacional, retrospectivo, en pacientes de 0- 16 años atendidos en urgencias pediátricas por sobreingesta de amoxicilina  entre 2011 y 2021. Se analizaron datos epidemiológicos, antropométricos,  circunstancias de la sobreingesta, síntomas, manejo y destino. RESULTADOS: Se incluyeron 15 pacientes, 66,6% varones, mediana de edad de  3,8 años (rango intercuartílico 1,9). La causa más frecuente de sobreingesta  fue la ingesta accidental por el paciente (8/15; 53,3%). Fue administrada en  forma de suspensión en todos los casos, excepto en un paciente con intención  autolítica (comprimidos). El 80% (12/15) recibieron una única dosis. La  mediana de tiempo de llegada a urgencias desde la sobreingesta fue de 2,1  horas (rango intercuartílico 2,7) y la mediana de dosis de 219 mg/kg/dosis  (rango intercuartílico 148). Todos estaban asintomáticos con exploración  normal. Se realizó analítica sanguínea en 7 (46,6%) y sedimento urinario en 2 (13,3%), sin alteraciones. Cinco (33,3%) recibieron carbón activado, con una mediana de tiempo hasta la administración de 1 hora (rango intercuartílico  1,2). Todos fueron dados de alta, suspendiendo el tratamiento 11 (73,3%). CONCLUSIONES: En este estudio, la sobredosificación de amoxicilina no se  relacionó con efectos adversos, a pesar de exceder las dosis recomendadas.

Sobredosificación por amoxicilina en urgencias pediátricas: Estudio descriptivo / Amoxicillin overdose in the pediatric emergency department: A descriptive study

Objetivo: Describir las características de los pacientes pediátricos atendidos en urgencias por sobreingesta de amoxicilina.Método: Estudio unicéntrico observacional, retrospectivo, en pacientesde 0-16 años atendidos en urgencias pediátricas por sobreingesta deamoxicilina entre 2011 y 2021. Se analizaron datos epidemiológicos,antropométricos, circunstancias de la sobreingesta, síntomas, manejo ydestino.Resultados: Se incluyeron 15 pacientes, 66,6% varones, medianade edad de 3,8 años (rango intercuartílico 1,9). La causa más frecuente de sobreingesta fue la ingesta accidental por el paciente (8/15;53,3%). Fue administrada en forma de suspensión en todos los casos,excepto en un paciente con intención autolítica (comprimidos). El 80%(12/15) recibieron una única dosis. La mediana de tiempo de llegadaa urgencias desde la sobreingesta fue de 2,1 horas (rango intercuartílico 2,7) y la mediana de dosis de 219 mg/kg/dosis (rango intercuartílico 148). Todos estaban asintomáticos con exploración normal. Serealizó analítica sanguínea en 7 (46,6%) y sedimento urinario en 2(13,3%), sin alteraciones. Cinco (33,3%) recibieron carbón activado,con una mediana de tiempo hasta la administración de 1 hora (rangointercuartílico 1,2). Todos fueron dados de alta, suspendiendo el tratamiento 11 (73,3%). (AU)

Objective: To describe the characteristics of pediatric patients treated inthe emergency department due to amoxicillin overdosing.Method: A retrospective single-center observational study was conducted on patients aged 0 to 16 years treated in a pediatric emergencydepartment due to amoxicillin overdosing between 2011 and 2021. Epidemiological and anthropometric data was collected as well as information on the circumstances of overdosing, clinical manifestations, emergency department management, and discharge destination.Results: The study comprised 15 patients, 66.6% of them male, with amedian age of 3.8 years (interquartile range: 1.9). The most frequent cause ofoverdosing was accidental ingestion (8/15; 53.3%). Amoxicillin was mainlyingested in liquid form, except for one case with autolytic attempt, where itwas ingested in the form of tablets. Eighty percent of subjects (12/15) received a single dose of the drug. The median time to presentation to emergencydepartment was 2.1 hours from ingestion (interquartile range: 2.7) and themedian dose of amoxicillin was 219 mg/kg/dose (interquartile range: 148).All patients were asymptomatic, with a normal physical examination. Bloodtests were performed in 7 patients (46.6%) and urinary sediment analysis in2 (13.3%), all of them without alterations. Activated charcoal was administered to 5 (33.3%), patients with a median time to administration of one hour(interquartile range: 1.2). All patients were discharged to their homes. Elevencases (73.3%) required withdrawal of amoxicillin. (AU)