[Assessment of quality indicators in pediatric poisoning in an emergency service]. / Evaluación de los indicadores de calidad en intoxicaciones pediátricas en un servicio de urgencias.

INTRODUCTION: Assessment of quality indicators allows clinicians to evaluate clinical assistance with a standard, to detect deficiencies and to improve medical assistance. MATERIAL AND METHOD: Patients who came to emergency services of a tertiary level hospital for suspicion of poisoning from January 2011 to June 2012 were assessed using 20 quality indicators of pediatric poisoning. Data collection was performed by retrospective review of clinical reports. RESULTS: A total of 393 patients were admitted for suspicion of poisoning (0.3% of all admissions).The standard was reached in 11 indicators and not reached in 6: administration of activated charcoal within 2hours of poison ingestion (standard=90%, result=83.5%); attention within the first 15minutes of arriving in the emergency service (standard=90%, result=60.4%); start of gastrointestinal decontamination within 20minutes of arrival in emergency services (standard=90%, result=29.7%); performing of electrocardiogram on the patients poisoned with cardiotoxic substances (standard=95%, result=87%); judicial communication of cases of poisoning that could conceal a crime (standard=95%, result=31.3%), and collection of the minimal set of information of poisoned patients (standard=90%, result=1.9%). Three indicators could not be evaluated as a consequence of the limited number of cases where they could be applied (<5). CONCLUSIONS: The main deficiencies are related to delay in assistance, collection of information and completion of judicial reports. Giving these patients priority, designing a checklist to collect the main points of their management, and creating obligatory fields for data in computerized medical records, are the main actions available to achieve pediatric poisoning quality indicators in this emergency service.

[Caustic ingestion: current situation and review of updated recommendations]. / Ingesta de cáusticos: situación actual y puesta al día de las recomendaciones.

BACKGROUND: Household product ingestion is the second cause of visiting an Emergency Department for poisoning in children. Among these products, caustics are of great interest because of their potential toxicity and risk of sequelae. OBJECTIVES: To describe the epidemiological and clinical features of patients admitted to our hospital due to possible caustic ingestion. To analyse the risk factors associated with oesophageal or gastric injury. To review the latest treatment recommendations. MATERIALS AND METHODS: Retrospective review of all patients admitted with suspicion of caustic ingestion between January 2005 and April 2010. Epidemiological, clinical and therapeutic aspects were recorded. RESULTS: A total of 78 patients were admitted, 45 (57.7%) were male, with a median age of 2.2 years (range: 1-17.3 years). In 13 cases the product was kept in a container different than the original. In 36 children, the family had induced vomiting or had given a liquid to dilute the product. Fifty two patients were symptomatic, and 46 of them had some sign on physical examination. Thirty nine oesophagoscopies were performed, and 7 oesophageal or gastric lesions were observed. When patients with normal and abnormal endoscopic findings were compared, the factors associated with an increased risk of mucosal injury were vomiting (P=0.01), and two or more symptoms at admission (P=0.03). No complication was described in patients without endoscopy. CONCLUSIONS: Family education about preventive and initial measures after caustic ingestion must be improved in an attempt to prevent wrong actions which can be harmful. Some patients might benefit from clinical observation without aggressive therapeutic measures.

[Morbidity of the newborn infant born to a diabetic mother in relation to macrosomia]. / Morbilidad del recién nacido hijo de madre diabética en relación con la macrosomía.

OBJECTIVE: A descriptive study of an infant of a diabetic mother was carried out in order to analyze if macrosomia (weight greater than P90 for gestational age) is a good criteria in order to predict associated complications. PATIENTS AND METHODS: A total of 382 diabetic mothers were attended between January 1994 and December 1996. RESULTS: Most of the complications were similar to those reported in the literature. In infants of diabetic mothers there is a significant increase in malformations (7.1%), sepsis (10.7%), hypertrophic cardiomyopathy (12.1%), respiratory distress (12.7%), hypoglycemia (50%), polyglobulia (30.4%) and jaundice (7.1%). We did not find any differences for traumatisms (8.25%), acute fetal suffering (19.6%) or hypocalcemia (1.8%). Respiratory distress was related to gestational age. CONCLUSIONS: The high weight for gestational age is a good parameter to predict complications in the infants of diabetic mothers.