Impact of a Disaster Drill on Waiting Times in a Pediatric Emergency Department.

OBJECTIVE: Emergency departments should improve their preparedness for mass casualty incidents (MCIs) through periodic drills. These exercises are conducted while maintaining regular care. The aim of this study was to determine the impact of a disaster drill in a pediatric emergency department (PED) on real patients' waiting times. METHODS: On September 10, 2019, a 4-h disaster drill was conducted in the PED of a tertiary pediatric hospital, with minimal staff reinforcement (2 nurses). Cases were real patients that came to the PED during the drill. The patients that visited the PED the day before were the control group. Variables analyzed were: age, sex, destination, triage level, time-to-triage, time-to-physician, length of PED stay, and percentage of patients visited within the optimal time according to triage level. RESULTS: Sixty-eight patients (case group) and 63 patients (control group) were analyzed; both groups were comparable except for the median age. There were no differences in time-to-triage, time-to-physician, and length of PED stay between the 2 groups. The percentage of patients visited within optimal time according to triage level was higher in the case group. CONCLUSIONS: Conducting an MCI drill in the PED, with minimal staff reinforcement, was not detrimental to real patients' waiting times.

Intoxicación por cannabis en menores de 3 años / Cannabis poisoning under the age of 3 years

El aumento en el consumo de cannabis y su trivialización por la población adulta se han traducido en un aumento de los casos de intoxicaciones agudas en niños. Se presenta un estudio observacional retrospectivo de los pacientes menores de 3 años intoxicados por cannabis entre 2012 y 2017 en un servicio de urgencias pediátricas (SUP). Se recogieron datos epidemiológicos, clínicos y toxicológicos. Se detectaron 10 intoxicaciones por cannabis. Nueve pacientes presentaron alteración en el nivel de conciencia. Solo en 2 casos la familia refirió la exposición al tóxico en la anamnesis inicial. La detección en cabello demostró exposición repetida en 2 pacientes. En conclusión, es necesario incluir la intoxicación por cannabis dentro del diagnóstico diferencial de los niños con clínica neurológica aguda no filiada. Ante la detección de cannabis en orina en el SUP, se debe solicitar la confirmación mediante técnicas específicas y valorar la posibilidad de exposiciones repetidas

The increased use of cannabis among adults and the general perception that cannabis is harmless has been accompanied by a rise in the number of acute poisoning cases among children. We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017. Epidemiologic and clinical data as well as toxicologic findings are reported. We found 10 cases of cannabis poisoning in our records. Nine of the patients had diminished consciousness. Only 2 families initially reported exposure to cannabis when interviewed. Repeated exposure was demonstrated by analysis of hair from 2 patients. We conclude that cannabis poisoning should be included in the differential diagnosis of young children with acute neurologic symptoms of unknown origin. When cannabis is detected in urine samples collected in the pediatric emergency department, more specific diagnostic techniques should be used to assess the possibility of repeated exposure

Cannabis poisoning under the age of 3 years. / Intoxicación por cannabis en menores de 3 años.

EN: The increased use of cannabis among adults and the general perception that cannabis is harmless has been accompanied by a rise in the number of acute poisoning cases among children. We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017. Epidemiologic and clinical data as well as toxicologic findings are reported. We found 10 cases of cannabis poisoning in our records. Nine of the patients had diminished consciousness. Only 2 families initially reported exposure to cannabis when interviewed. Repeated exposure was demonstrated by analysis of hair from 2 patients. We conclude that cannabis poisoning should be included in the differential diagnosis of young children with acute neurologic symptoms of unknown origin. When cannabis is detected in urine samples collected in the pediatric emergency department, more specific diagnostic techniques should be used to assess the possibility of repeated exposure.

ES: El aumento en el consumo de cannabis y su trivialización por la población adulta se han traducido en un aumento de los casos de intoxicaciones agudas en niños. Se presenta un estudio observacional retrospectivo de los pacientes menores de 3 años intoxicados por cannabis entre 2012 y 2017 en un servicio de urgencias pediátricas (SUP). Se recogieron datos epidemiológicos, clínicos y toxicológicos. Se detectaron 10 intoxicaciones por cannabis. Nueve pacientes presentaron alteración en el nivel de conciencia. Solo en 2 casos la familia refirió la exposición al tóxico en la anamnesis inicial. La detección en cabello demostró exposición repetida en 2 pacientes. En conclusión, es necesario incluir la intoxicación por cannabis dentro del diagnóstico diferencial de los niños con clínica neurológica aguda no filiada. Ante la detección de cannabis en orina en el SUP, se debe solicitar la confirmación mediante técnicas específicas y valorar la posibilidad de exposiciones repetidas.

Observación clínica: una alternativa segura a la radiología en lactantes con traumatismo craneoencefálico leve / Clinical observation: A safe alternative to radiology in infants with mild traumatic brain injury

Objetivo: En julio 2013 se cambió el protocolo de manejo del traumatismo craneoencefálico leve en urgencias, siendo la principal novedad la sustitución sistemática de las radiografías craneales en lactantes por la observación clínica. Los objetivos son determinar si este cambio ha implicado: 1) una disminución en la capacidad de detección de lesiones intracraneales (LIC) en la visita inicial de urgencias y 2) cambios en la solicitud de pruebas de imagen e ingresos. Metodología: Estudio retrospectivo, descriptivo-observacional. Se establecen 2 periodos: periodo 1 (1/11/2011-30/10/2012), preimplantación nuevo protocolo, y periodo 2 (1/11/2013-30/10/2014), postimplantación. Se incluyen las consultas por traumatismo craneoencefálico leve a urgencias (escala Glasgow modificada para lactantes ≥ 14) de ≤ 24h de evolución de niños ≤ 2 años. Resultados: Se incluyen 1.543 casos, 807 del periodo 1 y 736 del periodo 2, sin observarse diferencias significativas en sexo, edad, mecanismo y riesgo de LIC. En el periodo 1 se diagnostican más fracturas craneales que en el periodo 2 (4,3 vs. 0,5%; p<0,001) sin cambios significativos en la detección de LIC (0,4 vs. 0,3%; p=1). Asimismo, se realizan más radiografías de cráneo (49,7 vs. 2,7%; p<0,001), más ecografías (2,1 vs. 0,4%; p<0,001) e ingresan más casos (8,3% vs 3,1%; p<0,001). No se hallan diferencias significativas en las tomografías computarizadas realizadas (2 vs. 3%; p=0,203). Conclusiones: La observación clínica como alternativa a la radiografía craneal permite reducir las pruebas de imagen y los ingresos en los lactantes con traumatismo craneoencefálico leve sin disminuir la fiabilidad diagnóstica de LIC. Esta opción permite la reducción de irradiación al paciente y un uso más racional de los recursos sanitarios (AU)

Objective: The protocol for the management of mild cranioencephalic trauma in the emergency department was changed in July 2013. The principal innovation was the replacement of systematic X-ray in infants with clinical observation. The aims of this study were to determine whether there was, 1) a reduction in the ability to detect traumatic brain injury (TBI) in the initial visit to Emergency, and 2) a change in the number of requests for imaging tests and hospital admissions. Methodology: This was a retrospective, descriptive, observational study. Two periods were established for the study: Period 1 (1/11/2011-30/10/2012), prior to the implementing of the new protocol, and Period 2 (1/11/2013-30/10/2014), following its implementation. The study included visits to the emergency department by children≤2 years old for mild cranioencephalic trauma (Glasgow Scale modified for infants ≥ 14) of ≤ 24 hours onset. Results: A total of 1,543 cases were included, of which 807 were from Period 1 and 736 from Period 2. No significant differences were observed as regards sex, age, mechanism, or risk of TBI. More cranial fractures were detected in Period 1 than in Period 2 (4.3% vs 0.5%; P<.001), without significant changes in the detection of TBI (0.4% vs 0.3%; P=1). However, there were more cranial X-rays (49.7% vs 2.7%; P<.001) and more ultrasounds (2.1% vs 0.4%; P<.001) carried out, and also fewer hospital admissions (8.3% vs 3.1%; P<.001). There were no significant differences in the number of computerised tomography scans carried out (2% vs 3%; P=.203). Conclusions: The use of clinical observation as an alternative to cranial radiography leads to a reduction in the number of imaging tests and hospital admissions of infants with mild cranioencephalic trauma, without any reduction in the reliability of detecting TBI. This option helps to lower the exposure radiation by the patient, and is also a more rational use of hospital resources (AU)

[Clinical observation: A safe alternative to radiology in infants with mild traumatic brain injury]. / Observación clínica: una alternativa segura a la radiología en lactantes con traumatismo craneoencefálico leve.

OBJECTIVE: The protocol for the management of mild cranioencephalic trauma in the emergency department was changed in July 2013. The principal innovation was the replacement of systematic X-ray in infants with clinical observation. The aims of this study were to determine whether there was, 1) a reduction in the ability to detect traumatic brain injury (TBI) in the initial visit to Emergency, and 2) a change in the number of requests for imaging tests and hospital admissions. METHODOLOGY: This was a retrospective, descriptive, observational study. Two periods were established for the study: Period 1 (1/11/2011-30/10/2012), prior to the implementing of the new protocol, and Period 2 (1/11/2013-30/10/2014), following its implementation. The study included visits to the emergency department by children≤2 years old for mild cranioencephalic trauma (Glasgow Scale modified for infants≥14) of ≤24hours onset. RESULTS: A total of 1,543 cases were included, of which 807 were from Period 1 and 736 from Period 2. No significant differences were observed as regards sex, age, mechanism, or risk of TBI. More cranial fractures were detected in Period 1 than in Period 2 (4.3% vs 0.5%; P<.001), without significant changes in the detection of TBI (0.4% vs 0.3%; P=1). However, there were more cranial X-rays (49.7% vs 2.7%; P<.001) and more ultrasounds (2.1% vs 0.4%; P<.001) carried out, and also fewer hospital admissions (8.3% vs 3.1%; P<.001). There were no significant differences in the number of computerised tomography scans carried out (2% vs 3%; P=.203). CONCLUSIONS: The use of clinical observation as an alternative to cranial radiography leads to a reduction in the number of imaging tests and hospital admissions of infants with mild cranioencephalic trauma, without any reduction in the reliability of detecting TBI. This option helps to lower the exposure radiation by the patient, and is also a more rational use of hospital resources.

Escala clínica para el diagnóstico de disfunción de válvula ventriculoperitoneal en niños en el Servicio de Urgencias / Clinical scale for the diagnosis of ventriculoperitoneal shunt malfunction in children in Emergency Department

INTRODUCCIÓN: Es conocido que la presencia de determinadas manifestaciones clínicas en los niños portadores de una válvula ventrículo-peritoneal (VDVP) se asocia a un mayor riesgo de disfunción valvular (DV), sin embargo, ninguna de estas es suficientemente sensible y específica por sí sola para diferenciar los pacientes que presentan una DV de los que no, y permitir así una actuación diagnóstica y terapéutica más adecuada. OBJETIVO: Elaborar una escala diagnóstica que permita seleccionar en el Servicio de Urgencias a los niños con riesgo de DV. MATERIAL Y MÉTODOS: Estudio prospectivo. Se incluyó a los pacientes portadores de VDVP con edad comprendida entre 1 y 18 años que consultaron con sintomatología potencialmente asociada a DV en un Servicio de Urgencias durante 3 años (1 de abril del 2010-31 de marzo del 2013). Mediante regresión logística se determina qué variables se consideran factores de riesgo independientes de DV; con ellos se elabora una escala diagnóstica. RESULTADOS: Se obtiene una escala basada en 9 variables (eritema, tumefacción o secreción en el trayecto del catéter; somnolencia; rigidez de nuca; cefalea; ausencia de fiebre; edad mayor a 4 años; vómitos; focalidad neurológica reciente y tiempo desde la última intervención quirúrgica menor o igual a 2 años) con una puntuación máxima de 20 puntos. Puntuaciones de la escala de 7 o más puntos se asocian a un mayor riesgo de DV (OR 34,0; IC del 95%, 15,4-74,9; sensibilidad 88,3%; especificidad 81,1%; VPP 53,4%; VPN 96,7%). DISCUSIÓN: La escala diagnóstica para la valoración del riesgo de DV presentada permite seleccionar los pacientes con riesgo de DV. Su uso podría ayudar a mejorar la indicación de las pruebas complementarias que reciben los niños portadores de una VDVP y disminuir la irradiación a la que son sometidos estos pacientes

INTRODUCTION: It is well known that some symptoms in children with ventriculoperitoneal shunt are associated with a higher risk of developing shunt malfunction. However none of those symptoms are sensitive or enough specific enough to diagnose the shunt malfunction. OBJECTIVE: To develop a diagnostic scale to identify children with an increased risk of shunt malfunction in the Emergency Department. MATERIAL AND METHODS: This is a prospective study including children aged one to eighteen years old admitted to the Emergency Department between April 2010 and March 2013 with symptoms of ventriculoperitoneal shunt malfunction. Logistic regression Analysis was used to determine whether or not the variables were considered independent risk factors for shunt malfunction. The results led to the development of a diagnostic scale. RESULTS: A scale was developed using 9 variables (erythema, swelling or discharge from the catheter trajectory, drowsiness, stiff neck, headache, afebrile, age>4 years, vomiting, recent neurological deficit, and time since last surgery ≤ 2 years) with a maximum score of 20 points. It was found that Scale scores ≥ 7 points were associated with an increased risk of shunt malfunction (OR 34.0, 95% CI 15.4-74.9; sensitivity 88.3%, specificity 81.1%, PPV 53.4%, NPV 96.7%). DISCUSSION: A diagnostic scale is designed for assessing the risk of shunt malfunction, selecting those patients with a higher risk. The use of this scale could help the management of these patients, reducing complementary tests, as well the usual radiation suffered by these children

[Clinical scale for the diagnosis of ventriculoperitoneal shunt malfunction in children in Emergency Department]. / Escala clínica para el diagnóstico de disfunción de válvula ventriculoperitoneal en niños en el Servicio de Urgencias.

INTRODUCTION: It is well known that some symptoms in children with ventriculoperitoneal shunt are associated with a higher risk of developing shunt malfunction. However none of those symptoms are sensitive or enough specific enough to diagnose the shunt malfunction. OBJECTIVE: To develop a diagnostic scale to identify children with an increased risk of shunt malfunction in the Emergency Department. MATERIAL AND METHODS: This is a prospective study including children aged one to eighteen years old admitted to the Emergency Department between April 2010 and March 2013 with symptoms of ventriculoperitoneal shunt malfunction. Logistic regression Analysis was used to determine whether or not the variables were considered independent risk factors for shunt malfunction. The results led to the development of a diagnostic scale. RESULTS: A scale was developed using 9 variables (erythema, swelling or discharge from the catheter trajectory, drowsiness, stiff neck, headache, afebrile, age>4 years, vomiting, recent neurological deficit, and time since last surgery ≤ 2 years) with a maximum score of 20 points. It was found that Scale scores ≥ 7 points were associated with an increased risk of shunt malfunction (OR 34.0, 95% CI 15.4-74.9; sensitivity 88.3%, specificity 81.1%, PPV 53.4%, NPV 96.7%). DISCUSSION: A diagnostic scale is designed for assessing the risk of shunt malfunction, selecting those patients with a higher risk. The use of this scale could help the management of these patients, reducing complementary tests, as well the usual radiation suffered by these children.

Niños con traumatismo craneal leve en urgencias: ¿es necesaria la radiografía de cráneo en pacientes menores de 2 años? / Children with minor head injury in the emergency department: Is skull radiography necessary for children under 2 years?

INTRODUCCIÓN: La mayoría de publicaciones actuales sobre el manejo del traumatismo craneoencefálico (TCE) leve ya no tienen en cuenta la presencia de una fractura craneal para determinar el riesgo del lesión intracraneal (LIC). Sin embargo, en nuestro medio sigue siendo habitual la realización de radiografías de cráneo en los niños pequeños para descartar su presencia. OBJETIVO Determinar la prevalencia de LIC clínicamente importante (LICCI) en los niños menores de 2 años con TCE leve atendidos en urgencias. PACIENTES Y MÉTODOS: Revisión retrospectiva de los informes de urgencias de los niños menores de 2 años atendidos por TCE leve (Glasgow ≥ 14 puntos) durante un año. Se define LICCI aquella LIC que tiene como consecuencia la muerte, una intervención neuroquirúrgica, ventilación mecánica o soporte inotrópico. RESULTADOS: Se incluyen 854 niños, con una mediana de edad de 11,0 meses (P25-75: 7,5-17,0 meses). Cuatrocientos cincuenta y siete (53,5%) eran varones. En 741 casos (86,8%) el mecanismo del TCE fue una caída. En 438 (51,3%) se realizó una radiografía craneal. En 11 casos (1,3%) se diagnosticó una LIC, ninguna clínicamente importante (prevalencia de LICCI en niños menores de 2 años con TCE leve: 0%; IC 95% 0-0,4%). CONCLUSIONES: Los niños menores de 2 años con TCE leve tienen un riesgo muy bajo de LICCI. La observación clínica puede considerarse como una alternativa válida a la realización de radiografías de cráneo

BACKGROUND: Current guidelines on the management of mild head trauma (traumatic braininjury/TBI) do not include the presence of a skull fracture in determining the risk of intracranial injury. However, in our setting cranial radiography is still performed frequently to rule out the presence of skull fracture. OBJECTIVE: To estimate the prevalence of clinically-important traumatic brain injuries (ciTBI)in children younger than two years of age with mild TBI. PATIENTS AND METHODS: Descriptive observational study. All children attended in emergency department with mild TBI (Glasgow ≥ 14 points) for a year were included. We defined ciTBIas intracranial injuries that caused death or required neurosurgery, intubation for morethan 24hours, inotropic drugs or mechanical ventilation. RESULTS: The study included 854 children, of which 457 (53.5%) were male. The median patient age was 11.0 months (P25-75: 7.5-17.0 months). In 741 cases (86.8%) the mechanism of TBI was a fall. In 438 cases (51.3%) skull radiography was performed. Eleven children (1.3%) had intracranial injury, but none met the criteria for ciTBI (estimated prevalence of ciTBI was0%; CI 95%: 0%-0.4%). CONCLUSION: Children younger than two years of age with mild TBI have low prevalence of ciTBI. Consequently, it is possible to monitor children younger than two years with a TBI without performing skull radiography

[Children with minor head injury in the emergency department: Is skull radiography necessary for children under 2 years?]. / Niños con traumatismo craneal leve en urgencias: ¿es necesaria la radiografía de cráneo en pacientes menores de 2 años?

BACKGROUND: Current guidelines on the management of mild head trauma (traumatic brain injury/TBI) do not include the presence of a skull fracture in determining the risk of intracranial injury. However, in our setting cranial radiography is still performed frequently to rule out the presence of skull fracture. OBJECTIVE: To estimate the prevalence of clinically-important traumatic brain injuries (ciTBI) in children younger than two years of age with mild TBI. PATIENTS AND METHODS: Descriptive observational study. All children attended in emergency department with mild TBI (Glasgow ≥14 points) for a year were included. We defined ciTBI as intracranial injuries that caused death or required neurosurgery, intubation for more than 24 hours, inotropic drugs or mechanical ventilation. RESULTS: The study included 854 children, of which 457 (53.5%) were male. The median patient age was 11.0 months (P25-75: 7.5-17.0 months). In 741 cases (86.8%) the mechanism of TBI was a fall. In 438 cases (51.3%) skull radiography was performed. Eleven children (1.3%) had intracranial injury, but none met the criteria for ciTBI (estimated prevalence of ciTBI was 0%; CI 95%: 0%-0.4%). CONCLUSION: Children younger than two years of age with mild TBI have low prevalence of ciTBI. Consequently, it is possible to monitor children younger than two years with a TBI without performing skull radiography.

Metahemoglobinèmia secundària a absorció tòpica d'anilines / Metahemoglobinemia secundaria a absoricón tópica de anilinas / Methemoglobinemia due to topical absorption of anilines

Introducció: la metahemoglobinèmia adquirida és unacausa de cianosi poc freqüent en l'edat pediàtrica, causadaper l'exposició de l'hemoglobina a agents oxidants, com elsnitrits presents en algunes verdures, els anestèsics locals ialtres fàrmacs. La metahemoglobina produeix una disminució de la cessió d'oxigen als teixits i, com a conseqüència, símptomes derivats de la hipòxia tissular. Cas clínic: es presenta el cas clínic d'una pacient de 3 anysque va presentar dos episodis de metahemoglobinèmia secundària a l'absorció tòpica de les anilines amb quès'havien tenyit unes sabates. Comentaris: l'anilina és un compost orgànic que s'utilitzaper fabricar, entre altres, pintures sintètiques i colorantsindustrials. L'anilina pot ser tòxica si s'ingereix, si s'inhalao si s'absorbeix per via cutània, i pot provocar una metahemoglobinèmia

Introducción. La metahemoglobinemia adquirida es una causa de cianosis poco frecuente en la edad pediátrica, causada por la exposición de la hemoglobina a agentes oxidantes, como los nitritos resentes en algunas verduras, anestésicos tópicos y otros fármacos. La metahemoglobinemia produce una disminución de la cesión de oxigeno a los tejidos y, como consecuencia, síntomas derivados de la hipoxia tisular. Caso clínico. Se expone el caso clínico de una paciente de 3 años que presentó dos episodios de metahemoglobinemia secundaria a la absorción tópica de anilinas con las que se habían teñido sus zapatos. Comentarios. La anilina es un compuesto orgánico que se utiliza para fabricar pinturas sintéticas y colorantes industriales. La anilina puede ser tóxica si se ingiere, inhala o si se absorbe por vía cutánea, pudiendo provocar una metahemoglobinemia (AU)

Introduction. Acquired methemoglobinemia, a rare cause of cyanosis in children, is due to the exposure of hemoglobin to oxidizing agents such as nitrites, which are found in some vegetables, local anesthetics, and other drugs. Methemoglobin is an oxidized form of hemoglobin with decreased affinity for oxygen, which leads to decreased delivery of oxygen to tissues and resulting hypoxia. Clinical case. We report the case of a 3-year old child with two episodes of methemoglobinemia secondary to topical absorption of anilines. Comments. Anilines are organic compounds that are used for making synthetic paints and industrial dyes. If consumed, inhaled, or absorbed through the skin, they are toxic and may cause methemoglobinemia (AU)

Disfunción de válvula de derivación de líquido cefalorraquídeo: ¿cómo se presenta en la edad pediátrica? / Cerebrospinal fluid shunt malfunction: clinical presentation in the pediatric age group

Fundamento. La disfunción valvular es la complicación más grave que pueden presentar los niños portadores de una válvula de derivación de líquido cefalorraquídeo (LCR). Objetivo. Describir la forma de presentación de la disfunción valvular, las herramientas diagnósticas utilizadas y su evolución posterior. Método. Estudio descriptivo y observacional. Se incluyen todos los niños diagnosticados de disfunción valvular en urgencias en dos años (01/04/2010 - 31/03/2012). Se recogen variables epidemiológicas, antecedentes patológicos, tipo de disfunción, sintomato- Disfunció de vàlvula de derivació de líquid cefaloraquidi: com es presenta en l’edat pediàtrica? Arantxa Aparicio-Coll, David Muñoz-Santanach, Victoria Trenchs Sainz de la Maza, Carles Luaces Cubells Servei d’Urgències. Hospital Sant Joan de Déu. Universitat de Barcelona. Barcelona logía al diagnóstico, exploraciones complementarias realizadas y destino del paciente. Resultados. Se realizaron 542 consultas de niños portadores de una válvula de derivación de LCR. Se diagnosticaron 62 episodios (11,4 %) de disfunción valvular, que correspondieron a 41 pacientes. El tipo de disfunción más frecuente fue la obstrucción del catéter de drenaje. Los motivos de consulta más frecuentes fueron: cefalea, vómitos y somnolencia. En 59 episodios se realizó una neuroimagen, siendo la más frecuente la tomografía craneal, que se realizó en 57. En 47 episodios se realizó un trayecto valvular y en 13, un fondo de ojo. En el periodo de estudio no se produjo la muerte de ningún paciente. Conclusiones. La cefalea, los vómitos y la somnolencia son las manifestaciones clínicas más frecuentes el la disfunción valvular. La tomografía craneal es la herramienta más utilizada para diagnosticarla. La evolución fue favorable en todos los casos(AU)

Background. Shunt malfunction is the most serious complication of children with cerebrospinal fluid shunts (CFS). Aim. To describe the clinical presentation of shunt malfunction, the diagnostic tests used, and the likely outcome. Methods. This is a descriptive and observational study. All children with shunt malfunction diagnosed in the Emergency Department (ED) from 1st April 2010 to March 31st 2012 were included. We recorded epidemiological data, symptoms, investigations performed in the ED, final diagnosis and outcome of all patients. Results. During the study period, 542 children with CFS were attended. Sixty-two (11.4%) episodes of shunt dysfunction were diagnosed in 41 children. The most common type of shunt malfunction was catheter obstruction. Headache, vomiting and drowsiness were the most common symptoms. Neuroimaging was performed in 59 episodes (cranial CT in 57 episodes), shunt series in 47, and fundoscopy in 13. No patients died. Conclusions. The most common clinical manifestations of shunt malfunction include headache, vomiting and drowsiness. Cranial CT is the imaging procedure used most often to diagnose this disease. All patients recovered well(AU)

Deep vein thrombosis: rare cases of diagnoses in a pediatric emergency department.

Deep vein thrombosis (DVT) has an estimated annual incidence of 0.07/10,000 children. Early diagnosis suspicion in the emergency department is important because it is a serious disease that, if untreated, can lead to a postthrombotic disease or a pulmonary thromboembolism. We report 2 cases of DVT whose diagnosis was made in the pediatric emergency department. Case 1 is a 9-year-old boy, evaluated with corticodependent nephrotic syndrome, who presented with pain in the lower left limb and increase in size of 48 hours' evolution suggestive of DVT. The elevation of D-dimer in the blood analysis and images from the Doppler ultrasound confirmed the diagnosis. His clinical evolution was good after beginning treatment with low molecular weight heparin. Case 2 is a 16-year-old adolescent, mother of a 1-year-old infant, who took oral contraceptives and was an occasional smoker, showed increased size and had pain in the lower left limb of a few hours' evolution. Deep vein thrombosis was suspected, and the diagnosis was confirmed by Doppler ultrasound. The evolution was favorable after beginning treatment with low molecular weight heparin. Although DVT is rare in children, early detection is important, requiring a detailed case history in the presence of edematous, painful, and hot limbs that are keys to the diagnostic suspicion. The imaging test and the laboratory tests will confirm the diagnosis, and anticoagulant treatment will prevent complications.

Brote de sarampión 2006-2007: impacto sobre un servicio de urgencias / Measles outbreak in 2006-2007: impact on emergency services

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