Burnout syndrome in paediatricians working in paediatric emergency care settings. Prevalence and associated factors: a multilevel analysis.

INTRODUCTION: The aim of our study was to describe the prevalence of burnout syndrome (BOS) in paediatricians working in paediatric emergency care settings and to analyse its association with potential risk factors. MATERIAL AND METHODS: Multicentre cross-sectional study through a survey of paediatricians working in paediatric emergency care settings in hospitals affiliated to the Research Network of the Spanish Society of Paediatric Emergency Medicine (SEUP) between September 2019 and January 2020. We analysed the association between social/family-related, demographic, occupational and satisfaction factors and the presence of BOS by means of multivariate and multilevel mixed-effects logistic regression models. RESULTS: The estimated prevalence of BOS was 36.5% (95% confidence interval [CI], 31.7 %-41.2%). In the multivariate analysis, lacking a stable group of friends (OR, 2.57; 95% CI, 1.10-5.97), problems in and out of the work setting (OR, 3.06; 95% CI, 1.60-5.88) and a work experience of 9 years or less (OR, 2.31; 95% CI, 1.37-3.90) were identified as individual factors that increased the risk of SBO, while feeling acknowledged by coworkers (OR, 0.48; 95% CI, 0.30-0.79) and acknowledged by one's supervisor (OR, 0.62; 95% CI, 0.41-0.93) were protective factors. In relation to the hospital, the paediatric emergency unit being a subdepartment of the Department of Paediatrics (OR, 3.81; 95% CI, 1.85-7.85), the presence of an on-call emergency medicine specialist around the clock (OR, 3.53; 95% CI,1.62-7.73) and a volume of 28 or more paediatric emergency encounters a day to be managed per on-call physician (OR, 2.05; 95% CI, 1.01-4.16) were identified as independent risk factors for SBO. There was no variability in the prevalence of BOS attributable to differences between hospitals and autonomous communities, save for the described situations. CONCLUSIONS: The prevalence of SBO among these providers is high. There are modifiable factors that we can intervene on to address BOS, independently of the hospital or region.

Síndrome de burnout en pediatras con actividad asistencial en urgencias. Prevalencia y factores asociados. Análisis multinivel / Burnout syndrome in paediatricians working in paediatric emergency care settings. Prevalence and associated factors: A multilevel analysis

Introducción: El objetivo del estudio es describir la prevalencia de síndrome de burnout (SBO) entre pediatras con actividad en urgencias pediátricas (UP) y analizar su asociación con potenciales factores de riesgo. Material y métodos: Estudio de encuestas transversales multicéntrico entre pediatras con actividad asistencial en UP, en hospitales miembros de la Red de Investigación de la Sociedad Española de UP (RISeuP-SPERG), entre septiembre de 2019 y enero de 2020. Se analizó la relación de factores sociofamiliares, demográficos, laborales y de satisfacción con la presencia de SBO mediante modelos mixtos de regresión logística multivariable y multinivel. Resultados: La prevalencia estimada fue del 36,5% (IC95%: 31,7-41,2%). Tras el análisis multivariable, no disponer de un círculo de amigos estable (OR: 2,57; IC95%: 1,10-5,97), tener problemas en el ámbito laboral y extralaboral (OR: 3,06; IC95%: 1,60-5,88) y llevar trabajando 9años o menos (OR: 2,31; IC95%: 1,37-3,90) se presentaron como factores individuales que aumentaron el riesgo de SBO; sentirse reconocido por compañeros (OR: 0,48; IC95%: 0,30-0,79) y por el supervisor (OR: 0,62; IC95%: 0,41-0,93) parecieron actuar como protectores. En el ámbito hospitalario, que la urgencia dependiera del servicio de pediatría (OR: 3,81; IC95%: 1,85-7,85), siempre hubiera un especialista en urgencias de guardia (OR: 3,53; IC95%: 1,62-7,73) y que cada médico de guardia atendiera 28 episodios de urgencias/día o más (OR: 2,05; IC95%: 1,01-4,16) constituyeron factores de riesgo independiente para el SBO. No existió variabilidad en la presencia de SBO atribuible a la diferencia entre hospitales y comunidades autónomas, al margen de las situaciones descritas. (AU)

Introduction: The aim of our study was to describe the prevalence of burnout syndrome (BOS) in paediatricians working in paediatric emergency care settings and to analyse its association with potential risk factors. Material and methods: Multicentre cross-sectional study through a survey of paediatricians working in paediatric emergency care settings in hospitals affiliated to the Research Network of the Spanish Society of Paediatric Emergency Medicine (SEUP) between September 2019 and January 2020. We analysed the association between social/family-related, demographic, occupational and satisfaction factors and the presence of BOS by means of multivariate and multilevel mixed-effects logistic regression models. Results: The estimated prevalence of BOS was 36.5% (95% confidence interval [CI]: 31.7%-41.2%). In the multivariate analysis, lacking a stable group of friends (OR: 2.57; 95%CI: 1.10-5.97), problems in and out of the work setting (OR: 3.06; 95%CI: 1.60-5.88) and a work experience of 9years or less (OR: 2.31; 95%CI: 1.37-3.90) were identified as individual factors that increased the risk of SBO, while feeling acknowledged by coworkers (OR: 0.48; 95%CI: 0.30-0.79) and acknowledged by one's supervisor (OR: 0.62; 95%CI: 0.41-0.93) were protective factors. In relation to the hospital, the paediatric emergency unit being a subdepartment of the Department of Paediatrics (OR: 3.81; 95%CI: 1.85-7.85), the presence of an on-call emergency medicine specialist around the clock (OR: 3.53; 95%CI: 1.62-7.73) and a volume of 28 or more paediatric emergency encounters a day to be managed per on-call physician (OR: 2.05; 95%CI: 1.01-4.16) were identified as independent risk factors for SBO. There was no variability in the prevalence of BOS attributable to differences between hospitals and autonomous communities, save for the described situations. (AU)

SARS-COV-2 Infection in Children in Emergency Departments in Spain: A Multicenter Study.

OBJECTIVES: The first cases of infection by SARS-CoV-2 in the Spanish pediatric population were reported on early March 2020. Although most were mild or asymptomatic, new forms of clinical presentation and severity were reported with the evolution of the pandemic. We aimed to describe demographics, clinical features, and management of children with COVID-19 treated in Spanish emergency departments (EDs). METHODS: A multicenter registry including 15 pediatric EDs was carried out. Patients younger than 18 years with confirmed acute SARS-CoV2 infection diagnosed between March and August 2020 were included. RESULTS: Three hundred ninety-five patients were analyzed (median age, 4.3 years). Fifty-five (13.9%) had comorbidities, and 141 (35.7%) a household contact with confirmed COVID-19. The most reported symptoms were fever (85.2%) and cough (41.7%). Fifty (12.5%) were asymptomatic. Seventeen (4.9%) were not well-appearing at presentation. Children underwent a blood test in 26.7% and a chest X-ray in 21.4%; findings were often unremarkable. Symptomatic treatment was prescribed to 80%; 6 (1.7%) received antiviral treatment. Seventy-one (20.6%) were hospitalized, and 3 (0.9%) were admitted to the intensive care unit; no patient died. The main clinical diagnoses were fever without a source (38%) and upper respiratory tract infection (32.2%); 4 (1.1%) presented a multisystem inflammatory syndrome. CONCLUSIONS: Most pediatric COVID-19 cases in EDs during the first months of the pandemic were healthy, well-appearing children, presenting with fever +/- respiratory symptoms. In a significant number of cases, there was household transmission. Most children were managed as outpatients with symptomatic treatment, being exceptional the evolution to a serious illness.

How Much Do Parents Know About Pain in Their Children?

OBJECTIVES: Adequate pain control is essential to the comprehensive management of pediatric patients within the emergency department.The aim of this study is to evaluate parents' knowledge about pain in the pediatric population patient and secondarily describe erroneous concepts that can affect a correct children's pain management. METHODS: A single-center descriptive study of cross-sectional surveys was performed between October and December 2018, with a previously validated ad hoc and anonymous questionnaire consisting of 9 items. All parents/guardians participating in the study had a child aged 0 to 18 years who had been admitted to the emergency department. RESULTS: Sixty-nine percent (n = 315) were women, 49.9% (n = 226) had university degrees and only 11% (n = 50) had professions related to the healthcare system. A linear association was observed between the number of correct answers and the level of education (ß = 1.04; 95% confidence interval, 0.76-1.32; P < 0.001), as well as between parents with professions related to the healthcare system compared with other professions (61.4% vs 51.2% with P = 0.005). The responses of Spanish parents offered better results than answers obtained from parents from the American continent (56.4% vs 41.4% with P < 0.001). No differences were observed between parents of children with chronic diseases. CONCLUSIONS: In our study, we observed that a considerable percentage of parents hold misconceptions about how children express pain, and therefore, it would be necessary to encourage formation programs for parents to help identify, evaluate, and correctly treat pain in their children.

Inhaler technique in a pediatric emergency department: Impact of an education intervention among healthcare professionals.

BACKGROUND: Inhaler technique (IT) knowledge among healthcare providers is poor. The aim was to improve Pediatric Emergency Department (PED) healthcare providers' IT technique by carrying out an education intervention and sustain it for 6 months. METHODS: Open-label, quasi-experimental, prospective, and unicentric study. Healthcare professionals working at the PED were enrolled. The study was developed in three phases: baseline evaluation and education intervention (P1) and reevaluation 1 month (P2) and 6 months (P3) after the education intervention. Participants fulfilled an eight-question theoretical test. Practical skills were evaluated by demonstrating IT in all three phases. The education intervention consisted in a verbal explanation of IT followed by a demonstration of IT with metered-dose inhaler using a mannequin. RESULTS: A total of 84 healthcare providers (medical residents, nurses, and nursing assistants) were involved. In the theoretical questionnaire, the mean score at baseline was 4.4/8 (SD 1.7) improving to 6.3/8 (SD 1.2) in P2 and 6.47/8 (SD 1.1) in P3. In the IT evaluation for children <7 years old, the score improved from 5.7/7 (SD 1.3) to 6.5/7 in P2 and 6.7/7 in P3 (p < 0.001). For children >7 years old, the mean score of IT at baseline was 3.1/10 (SD 4), which improved to 7.4/10 (SD 3) and 8.2/10 in P2 and P3, respectively (p < 0.001). Only professional category influenced results at baseline. CONCLUSION: Healthcare providers' theoretical knowledge and practical skills on IT are low. The education intervention performed is a useful strategy to ameliorate IT among healthcare providers.

Evaluation of the PECARN rule for traumatic brain injury applied to infants younger than 3 months and creation of a modified, age-specific rule.

Infants < 3 months with minor head trauma (MHT) are a particularly vulnerable group, though few studies have focused specifically on these patients. We aimed to evaluate the application of the PECARN prediction rule, designed for clinically important traumatic brain injury (ciTBI) in children < 2 years in infants < 3 months, and create a specific prediction rule for this population. We conducted a prospective multicenter observational study in 13 pediatric emergency departments (PEDs) in Spain. The PECARN rule was applied to all patients. A new specific prediction rule for infants < 3 months of age was created. The main outcome measures were (1) ciTBI, (2) TBI evidenced on computed tomography (CT) scan, and (3) isolated skull fracture (ISF). Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 21,981 children with MHT, 366 (1.7%) were < 3 months old and 195 (53.3%) underwent neuroimaging, including 37 (10.1%) with CT scan. The sensitivity and negative predictive value (NPV) of the PECARN prediction rule for ciTBI were 100% (95% CI, 20.7-100) and 99.7% (95% CI, 98.4-100%), respectively. Of the 230 infants (62.8%) who met the PECARN low-risk criteria, none had ciTBI, 1 (0.4% overall, 95% CI, 0-2.4) had TBI on CT, and 2 (0.9% overall; 95% CI, 0.1-3.1) had an ISF. Among the 136 infants (37.2%) who did not meet the PECARN low-risk criteria, 1 (0.3% overall; 95% CI, 0-1.5) had ciTBI, 11 (8.1% overall; 95% CI, 4.1-14.0) had TBI on CT, and 18 (13.2% overall; 95% CI, 8-20.1) had an ISF. The sensitivity and NPV of the Spanish prediction rule for ciTBI were 100% (95% CI, 20.7-100) and 100% (95% CI, 98.4-100%), respectively. No infants in the registry developed complications during follow-up. CONCLUSION: The PECARN rule for infants < 2 years old accurately identified infants < 3 months old at low risk for ciTBI in our population, although the adapted Spanish rule presented here could be even more accurate. WHAT IS KNOWN: • Infants younger than 3 months are vulnerable to minor blunt head trauma due to their age and to difficulties in assessing the subtle symptoms and minimal physical findings detected on examination. • A low threshold for CT scan is recommended in this population. WHAT IS NEW: • PECARN rule for infants < 2 years old is an adequate tool with which to identify infants < 3 months old at low risk for clinically important traumatic brain injury. • Spanish rule could identify even more low-risk infants without overlooking important outcomes but it should be validated to confirm its predictive capacity.

Acute Alcohol Intoxication in Pediatric Emergencies.

INTRODUCTION: Alcohol intoxication in pediatrics is a growing problem in our environment. The objectives of this study are to define the prevalence of acute alcohol intoxication in the pediatric emergency department (PED) and to describe the associated symptoms and their relationship with potential risk factors. METHODS AND MATERIAL: This cross-sectional study includes patients younger than 16 years with a diagnosis of acute alcohol intoxication between March 2010 and October 2018 in the PED of a tertiary hospital. Patients with concomitant intoxication by other substances were excluded. The association between qualitative variables was determined using the χ 2 or Fisher exact test and quantitative with the Student t , Mann-Whitney U test, and simple linear regression. RESULTS: There were 136 episodes of alcohol intoxication, which represents a prevalence of 24.1/100,000 emergencies. After excluding 10 patients because of positive screening for other drugs, 126 patients with a mean age of 14.5 years (SD, 1.2 years) were included, 57.9% of whom were women. A total of 25.4% of the patients were younger than 14 years. Ethanolemia was determined in 88.9%, and its mean concentration was 195.7 mg/dL (SD, 56.5 mg/dL), with potentially serious levels (>300 mg/dL) being found in 3.6% of the patients. A relationship was found between the Glasgow Coma Scale score and ethanolemia ( B = -12.7; 95% confidence interval, -8.1 to -17.4; P < 0.001), as well as with potassium ( B = -31, 9; 95% confidence interval, -6.6 to -57.3; P = 0.014). No patient had seizures or hypoglycemia. A total of 10.3% of the patients required admission. CONCLUSIONS: Alcohol intoxication is a rare consultation reason in the PED. They usually present with mild and self-limited symptoms, being the decrease in the level of consciousness and hypokalemia the most frequent symptom and analytical alteration.

Risk Factors of Serious Bacterial Infection in Previously Healthy Children Older Than 90 Days Old With Fever and Neutropenia.

BACKGROUND: The main objective was to determine the clinical or analytical factors that independently predict risk of serious bacterial infection (RSBI) in immunocompetent patients older than 90 days given a diagnosis of fever and for whom neutropenia was an incidental finding. The secondary objective was to describe the prevalence of serious bacterial infections (SBIs). METHODS: This is a 3-year-long, multicenter, prospective analytical and observational study carried out at 6 pediatric emergency departments. Data for epidemiological, clinical, and analytical variables were collected. RESULTS: One hundred forty patients with febrile neutropenia (60.7% mild, 39.3% moderate to severe) were recruited. Serious bacterial infection incidence was 15.0% (95% confidence interval [CI], 9-21): 1 Invasive Bacterial Infection (Staphylococcus epidermidis bacteremia), 10 urinary tract infections, 8 pneumonias, and 2 cellulitis. Median total neutrophil counts per microliter showed no statistically significant differences (P = 0.512; 1000 [750-1200] in SBI patients vs 1100 [800-1300] in non-SBI patients). Higher RSBI was observed in patients with neutrophils less than 20% relative to total leukocytes (SBI, 15, 26.3%) than in those with neutrophils of 20% or greater (SBI, 6, 7.2%) (odds ratio, 4.6; 95% CI, 1.7-12.7). In patients with greater than 5000 leukocytes/µL, a percentage of neutrophils less than 20% was related to a greater RSBI with a trend toward statistical significance (odds ratio, 6.1; 95% CI, 0.7-51.1; P = 0.066). The clinical variables did not show a significant association with RSBI. CONCLUSIONS: None of the clinical or analytical variables assessed were associated with the RSBI. However, according to a post hoc analysis, in patients with greater than 5000 leukocytes/µL, a neutrophil percentage less than 20% could be an independent risk factor for SBI. A thorough physical examination and basic diagnostic tests (urinalysis and chest x-ray) may help to establish a diagnosis of SBI in the vast majority of cases.

Pain Prevalence Among Children Visiting Pediatric Emergency Departments.

OBJECTIVES: The main purpose of this study was to investigate the prevalence, characteristics, and intensity of children's pain in emergency departments. The secondary purpose was to evaluate the interobserver agreement regarding the level of pain perceived by professionals, parents, and children. METHODS: This was a multicenter, survey-based research study on 0- to 18-year-old patients visiting 1 of the 15 hospitals that form part of the Working Group on Analgesia and Sedation of the Spanish Society of Pediatric Emergency Medicine between October and December 2018. The surveys recorded pain presence, intensity, characteristics, and location. RESULTS: The study included 1216 surveys. At the time of the interview, 646 patients were experiencing pain, a prevalence of 53.1% (95% confidence interval, 50.3%-55.9%), with 25.38% reporting mild, 36.68% moderate, and 37.46% intense pain. Among the patients, 29.9% had abdominal pain and 14.1% pain in their legs.The pain lasted less than 24 hours in 48.2% of the patients, whereas only 3.0% experienced pain during more than 15 days. The parents of 50.7% of the children had provided an analgesic at home.Interrater agreement regarding pain levels was k = 0.35 between professionals and children, k = 0.38 between children and parents, and k = 0.17 between parents and professionals. For children unable to cooperate, the agreement between professional/child and the parents was k = 0.11. CONCLUSIONS: Pain is a common symptom among emergency department patients, and its evaluation should therefore be obligatory. We found low interrater agreement on pain levels between patients, professionals, and parents, which confirms how difficult it is to accurately evaluate pain intensity.

¿Podemos usar las técnicas de estimulación de la micción siempre que la situación clínica lo permita? / Can we use bladder stimulation whenever the clinical situation allows it?

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Adecuacy of pediatric antimicrobial prescribing in the Emergency Department at discharge.

INTRODUCTION: In January 2019, the Community of Madrid's Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. MATERIAL AND METHODS: An observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. RESULTS: 165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (κ = 0.308; κ = 0.000; κ = 0.586). CONCLUSIONS: The adequacy of the management of infectious processes to the reference Guide in our pediatric ED was high, but it was below 50% when antimicrobial treatment was required. The degree of adequacy to the local protocols of the center was greater than to the regional Guide. This reveals a discrepancy between the 2 documents that should be analyzed and corrected according to the available scientific evidence.

Adecuación de la prescripción de antimicrobianos en procesos ambulatorios atendidos en Urgencias / Adecuacy of pediatric antimicrobial prescribing in the Emergency Department at discharge

Introducción: En enero del 2019 la Consejería de Sanidad de la Comunidad de Madrid publicó una guía acerca del uso de antimicrobianos en niños con tratamiento ambulatorio. El objetivo de este trabajo fue estimar la adecuación de la prescripción de antimicrobianos al alta desde el Servicio de Urgencias Pediátricas (SUP) en pacientes con enfermedades infecciosas, tomando como referencia esta guía regional. Secundariamente, se estudió la variación en la adecuación según el diagnóstico realizado y el facultativo prescriptor, y se valoró la concordancia entre dicha guía y los protocolos del centro. Material y métodos:Estudio observacional, descriptivo y retrospectivo en el que se incluyó a pacientes de 0-16 años con diagnóstico al alta del SUP incluido en la guía regional, entre marzo del 2018 y febrero del 2019. La prescripción se consideró adecuada cuando lo era la indicación, y en su caso, el fármaco elegido, la posología (dosis, intervalo y duración) y la vía de administración. Resultados: Se obtuvo una muestra de la que se analizaron 648 procesos infecciosos, siendo tratados con antimicrobianos 165 (25,5%). En 23 procesos no pudo evaluarse la adecuación a la guía por ausencia de algún dato posológico de la prescripción de antimicrobiano. El manejo terapéutico fue adecuado globalmente en 550/625 procesos (88,0%). En los procesos tratados con antimicrobiano, la adecuación fue de 70/142 (49,3%), sin encontrarse diferencias estadísticamente significativas entre facultativo prescriptor. El motivo de inadecuación más frecuente fue el error posológico (26,3%). Infección urinaria, conjuntivitis y otitis media aguda fueron las entidades clínicas con peor adherencia (el 44,4, el 50,0 y el 52,2% respectivamente) y en las que existió una mayor discrepancia entre guía y protocolos (κ=0,308; κ=0,000; κ=0,586). (AU)

Introduction: In January 2019, Community of Madrid's Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. Material and methods: An observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. Results: 165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (k=0.308; k=0.000; k=0.586). (AU)

Analysis of the validity of the five-level TRIPED-GM paediatric triage system.

OBJECTIVE: To determine the validity of the five-level TRIPED-GM pediatric triage system. METHODS: Unicentric, observational, descriptive, cross-sectional study of 485 patients aged 0-16 years in the pediatric emergency department of the HGU Gregorio Marañon. Two measures of validity were used: a direct measure calculated by the sensitivity and specificity obtained based on the number of infratriages and overtriages of the priorities given by classification nurses compared with a panel of experts and another indirect measure by the length of stay, the resources consumed and the percentage of income for each priority level. RESULTS: 10 patients were incorrectly classified, 4 (0.8%) were considered infratriages and 6 (1.2%) overtriages. The results showed a sensitivity of 99.45% (95% CI 96.5-99.97%) and a specificity of 99.01% (95% CI 96.9-99.7%) for high priorities (P2 and P3) and 98.99% (95% CI 96.8-99.6%) and 98.4% (95% CI 96.84-99.74%) respectively for low priorities (P4 and P5). The quadratic weighted Kappa index was 0.96 (95% CI 0.94-0.98; p = 0.0000). Resource consumption showed moderate Spearman correlation coefficients as the priority level increased. The percentage of admissions and the need for observation increased as the priority level p = 0,000 increased, not requiring observation or admitting any patients with priority 5. CONCLUSIONS: The TRIPED-GM pediatric triage system is valid for use in emergency departments with similar patients.

[Covid-19 pandemic impact in pediatricians: stress factors and their consequences]. / El impacto de la epidemia Covid-19 en los pediatras: factores estresantes y sus consecuencias.

Previous studies have demonstrated that the COVID-19 pandemic has had negative psychological consequences on healthcare professionals, however, specific data on pediatricians are scarce. Ob jective: To evaluate anxiety among pediatricians after the first COVID-19 wave as well as to identify possible related risk factors. MATERIAL AND METHOD: A cross-sectional multicentric survey study was designed and sent to Spanish pediatricians through the Asociación Española de Pediatría's e-mail lists. Demographic, socio-familial, occupational, emotional self-perception, psychosomatic symptoms, smoking, alcohol, and psychotropic drugs use data were collected. The State-Trait Anxiety Scale (STAI) was included, and its association with qualitative and quantitative variables of the sample was studied. RESULTS: 440 surveys were registered. 42.2% of the participants expressed moderate-intense anxiety symptomatology according to the Anxiety-State scale and 26.9% on the Anxiety-Trait scale. Isolation at home was associated with a higher score on both scales. A change in the work situation of the cohabitant resulted in a higher score on the Anxiety-State scale. 41.1% of the respondents clas sified the psychological impact suffered as mild, 50% as moderate, and 8.9% as severe. Up to 71.8% of the participants manifested some psychosomatic symptoms, with a linear association between the concurrence of symptoms and higher scores on the two scales. CONCLUSIONS: After the first pandemic wave, pediatricians have suffered anxiety, causing physical and emotional discomfort. Personal sit uations were the main source of concern. Likewise, the presence of several somatic symptoms was associated with higher levels of anxiety.

Contamination in Urine Samples Collected Using Bladder Stimulation and Clean Catch Versus Urinary Catheterization in Infants Younger Than 90 Days.

OBJECTIVES: The objective of this study was to compare the risk of contamination for urine samples collected from patients younger than 90 days using 2 different techniques: bladder stimulation and "clean catch" (CC) and urinary catheterization (CATH). METHODS: A case-control study was carried out in the pediatric emergency room of a tertiary hospital between January 2016 and September 2017. All urine samples collected from patients younger than 90 days by CC or CATH were included. The incidence of contaminated urine samples was compared for both methods, and the risk of contamination was estimated using univariate and multivariate analyses. RESULTS: A total of 473 urine samples were collected, 310 via CATH (65.5%) and 163 via CC (34.5%). The median age was 1.4 months (interquartile range, 0.8-2.1 months), and 54.1% were males. Seventeen patients had a history of urinary tract infection (3.6%), and 16 were diagnosed with a congenital urorenal anomaly (3.4%). Sixteen urine samples were found to be contaminated (3.4%): 5 collected via CATH (1.6%) and 11 via CC (6.8%). The univariate analysis revealed a greater risk of contamination in specimens obtained using CC versus CATH (odds ratio, 4.41; 95% confidence interval, 1.51-12.93), and the multivariate analysis confirmed CC collection as an independent risk factor for contamination (odds ratio, 5.61; 95% confidence interval, 1.83-17.19). CONCLUSIONS: The number of contaminated urine samples in infants younger than 90 days in our pediatric emergency department is low. However, using the CC urine collection technique seems to be an independent risk factor for sample contamination.

[Adecuacy of pediatric antimicrobial prescribing in the Emergency Department at discharge]. / Adecuación de la prescripción de antimicrobianos en procesos ambulatorios atendidos en Urgencias.

INTRODUCTION: In January 2019, Community of Madrid's Health Department published a guide about the use of antimicrobials in outpatient children. Taking this regional Guide as reference, this study was aimed at estimating the adequacy of the antimicrobial stewardship at discharge from a pediatric Emergency Department (ED). Secondarily, the differences in adequacy according to the diagnosis and the prescriber were studied, and the agreement between this Guide and the protocols of the ED was assessed. MATERIAL AND METHODS: An observational, descriptive, retrospective study was conducted on patients under 16 years old, with a diagnosis included in the regional Guide who were discharged from a pediatric ED between March of 2018 and February of 2019. Prescription was considered adequate when the indication, the antibiotic and the posology (dosage, dosing interval, length of treatment and route of administration) were correct. RESULTS: 165 out of 648 (25,5%) infectious diseases processes analyzed received antimicrobial treatment. In 23 processes treated with antimicrobial, the adequacy could not be evaluated due to the absence of data necessary to assess any aspect of posology. Therapy was considered appropriate in 550/625 processes (88.0%). When antimicrobial treatment was prescribed, 70/142 (49.3%) were appropriate and no statistically significant differences in adequacy were found between prescribers. Posology was the worst handled point of the prescription (26.3%). Tract urinary infection, conjunctivitis and otitis media were the pathologies with the lowest adecuacy (44.4%; 50.0% and 52.2%) and presented the highest discrepancy between the Guide and the center protocols (k=0.308; k=0.000; k=0.586). CONCLUSIONS: The adequacy of the management of infectious processes to the reference Guide in our pediatric ED was high, but it was below 50% when antimicrobial treatment was required. The degree of adequacy to the local protocols of the center was greater than to the regional Guide. This reveals a discrepancy between the 2documents that should be analyzed and corrected according to the available scientific evidence.

Manejo y factores de riesgo de gravedad asociados a lesiones no intencionadas en urgencias de pediatría en España / Management and serious risk factors associated with unintentional injuries in paediatric emergencies in Spain

INTRODUCCIÓN: Cada año se tratan 38 millones de pacientes con lesiones en los servicios de Urgencias, siendo el 90% en forma de lesiones no intencionadas (LNI). Actualmente no existen registros globales de su manejo en España ni de los factores de riesgo que puedan llevar asociados. Nuestro objetivo es describir el manejo de las LNI en los Servicios de Urgencias Pediátricos (SUP) y analizar los factores relacionados con la presencia de lesiones graves. MATERIAL Y MÉTODOS: Subestudio de estudio observacional prospectivo multicéntrico desarrollado durante 12 meses en 11 SUP de hospitales de la Red de Investigación de la Sociedad Española de Urgencias Pediátricas (RiSEUP-SPERG), incluyéndose niños de 0 a 16 años de edad que consultan por una LNI, los días 13 de cada mes. Se registraron datos epidemiológicos, circunstancias de la lesión y datos sobre la atención en el SUP y destino al alta. RESULTADOS: Se registraron 10.175 episodios, de los que 1.941 fueron LNI (19,1%). Se incluyeron 1.673, de los cuales 257 (15,4%) fueron graves. La prueba complementaria realizada más frecuentemente fue la radiografía simple (60,0%) y el procedimiento más frecuente fue la inmovilización de extremidad (38,6%). Se encontró asociación significativa entre presentar una LNI grave y la edad > 5 años (OR 2,24; IC 95%: 1,61-3,16), el antecedente de fractura (OR 2,05; IC 95%: 1,22-3,43) o la actividad deportiva como mecanismo lesional (OR 1,76; IC 95%: 1,29-2,38), entre otros. CONCLUSIÓN: En España, la mayoría de los casos de LNI no son graves. Las radiografías y la inmovilización de extremidades son las pruebas y procedimientos más frecuentemente realizados. La LNI grave se asoció con factores individuales, como la edad > 5 años o el antecedente de fractura, y con la actividad deportiva como mecanismo asociado a gravedad. Resulta vital implementar medidas para mejorar la prevención de estas lesiones y apoyar la capacitación de los cuidadores mediante programas educacionales

INTRODUCTION: Thirty-eight million patients with injuries are treated in Emergency Departments every year, 90% of them being in the form of unintentional injuries (UIs). There are currently no global records of its management in Spain, or the risk factors that may be associated with them. The objective of this study is to describe the management of UIs in Spanish paediatric emergency departments, and to analyse factors related to the presence of serious injuries. MATERIAL AND METHODS: A sub-study of a prospective multicentre observational study conducted over 12 months in 11 hospitals of the Spanish Paediatric Emergency Research Group (RiSEUP-SPERG), including children from 0 to 16 years of age consulting for UIs. Epidemiological data, circumstances of the injury, and data on emergency care and discharge destination were recorded on the 13 th day of each month. RESULTS: A total of 10,175 episodes were recorded, of which 1,941 were UIs (19.1%), including 1,673, of which 257 (15.4%) were severe. The most frequent complementary test was simple radiography (60.0%), and the most frequent procedure was limb immobilisation (38.6%). A significant relationship was found between presenting with a severe UI and age > 5 years (OR 2.24; 95% CI: 1.61-3.16), history of fracture (OR 2.05; 95% CI: 1.22-3.43), or sports activity as a mechanism of injury (OR 1.76; 95% CI: 1.29-2.38), among others. CONCLUSION: In Spain, most UIs are not serious. X-rays and immobilisation of extremities are the most frequently performed tests and procedures. Severe UIs were associated with individual factors, such as age > 5 years or history of fracture, and with sports activity as a mechanism associated with severity. It is vital to implement measures to improve the prevention of these injuries and to support the training of caregivers through educational programmes

[Management and serious risk factors associated with unintentional injuries in paediatric emergencies in Spain]. / Manejo y factores de riesgo de gravedad asociados a lesiones no intencionadas en urgencias de pediatría en España.

INTRODUCTION: Thirty-eight million patients with injuries are treated in Emergency Departments every year, 90% of them being in the form of unintentional injuries (UIs). There are currently no global records of its management in Spain, or the risk factors that may be associated with them. The objective of this study is to describe the management of UIs in Spanish paediatric emergency departments, and to analyse factors related to the presence of serious injuries. MATERIAL AND METHODS: A sub-study of a prospective multicentre observational study conducted over 12months in 11hospitals of the Spanish Paediatric Emergency Research Group (RiSEUP-SPERG), including children from 0 to 16years of age consulting for UIs. Epidemiological data, circumstances of the injury, and data on emergency care and discharge destination were recorded on the 13th day of each month. RESULTS: A total of 10,175 episodes were recorded, of which 1,941 were UIs (19.1%), including 1,673, of which 257 (15.4%) were severe. The most frequent complementary test was simple radiography (60.0%), and the most frequent procedure was limb immobilisation (38.6%). A significant relationship was found between presenting with a severe UI and age >5 years (OR2.24; 95%CI: 1.61-3.16), history of fracture (OR2.05; 95%CI: 1.22-3.43), or sports activity as a mechanism of injury (OR1.76; 95%CI: 1.29-2.38), among others. CONCLUSION: In Spain, most UIs are not serious. X-rays and immobilisation of extremities are the most frequently performed tests and procedures. Severe UIs were associated with individual factors, such as age >5years or history of fracture, and with sports activity as a mechanism associated with severity. It is vital to implement measures to improve the prevention of these injuries and to support the training of caregivers through educational programmes.