Registro de traumatismos craneoencefálicos leves: estudio multicéntrico de la Sociedad Española de Urgencias Pediátricas / Registry of mild craniocerebral trauma: Multicentre study from the Spanish Association of Pediatric emergencies

Objetivo: Revisar la actuación habitual ante un traumatismo craneal (TCE) leve en los Servicios de Urgencias y determinar los factores predictivos más importantes de lesión intracraneal (LIC). Material y métodos: Estudio multicéntrico prospectivo de 18 meses de duración realizado en 9 hospitales españoles. Se recogieron los datos de los pacientes menores de 18 años atendidos en Urgencias por TCE leve (puntuación en la escala de Glasgow de 13 a 15) en las 72h previas. Resultados: Se incluyeron 1.070 pacientes (61,2% de sexo masculino). La mediana de edad fue de 2,4 años (P 25-75%; de 0,9 a 6,4 años). La mediana de tiempo trascurrido desde el TCE hasta la consulta fue de 1h (P 25-75%; de 0,6 a 2,5h). Se practicó radiografía simple de cráneo al 64,5% de los niños y tomografía computarizada al 9%, resultó normal el 91,4% y el 84,4%, respectivamente. La prevalencia de LIC fue del 1,4% en la muestra total (intervalo de confianza [IC] del 95%: de 0,8 a 2,3). Precisó ingreso el 25,3% de los pacientes, 4 (3,7%) requirieron neurocirugía y ningún niño falleció. En el análisis multivariante, las variables que se asociaron a un riesgo incrementado de LIC fueron la pérdida de conciencia (odds ratio [OR] de 4,2; IC del 95%: de 1,1 a 17; p = 0,045), el deterioro neurológico (OR de 8,8; IC del 95%: de 2,1 a 37,6; p = 0,003) y la detección de un cefalohematoma (OR de 14,6; IC del 95%: de 4,9 a 44; p<0,001). Conclusiones: La combinación de parámetros clínicos permite seleccionar de forma adecuada a los pacientes con TCE leve que precisan exploraciones complementarias. En consecuencia, el uso rutinario de la radiografía de cráneo no parece justificado (AU)

Objective: To determine management practices of minor head trauma in children evaluated at Spanish Hospital Emergency Departments and to determine patient variables associated with intracranial injury. Methods: Multicenter and prospective study during 18 months in 9 hospitals in Spain. Patients up to the age of 18 years with minor head trauma (Glasgow Coma Scale score higher than or equal to 13 on admission), treated in Emergency Departments and with a maximum onset of 72h since the traumatism, were included in the study. Results: A total of 1070 patients were studied with a median age of 2.4 years (p25-75 0.9 6.4 years); 61.2% were male. The median time between head trauma and medical consultation was 1 hour (p25-75 0.6 2.5h). Skull X-rays were performed on 64.5% of the children and a head CT scan on 9%; 91.4% of X-ray and 84.4% of CT were normal. The prevalence of intracranial injury was 1.4% (95% CI: 0.8 2.3). Twenty-five point three percent of the patients were admitted; 4 (3.7%) required neurosurgical intervention during admission. None of the patients died. Multiple logistic regression analysis identified loss of consciousness (OR 4.2, 95% CI: 1.1 17; P=0.045), neurological deterioration (OR 8.8, 95% CI: 2.1 37.6; P=0.003) and cephalhaematoma (OR 14.6, 95% CI: 4.9 44; P <0.001) as independent predictors of intracranial injury. Conclusions: The combination of clinical parameters allows selection of patients with minor head trauma who need complementary explorations. In consequence, the routine use of skull X-ray in their initial evaluation is unnecessary (AU)

[Registry of mild craniocerebral trauma: multicentre study from the Spanish Association of Pediatric emergencies]. / Registro de traumatismos craneoencefálicos leves: estudio multicéntrico de la Sociedad Española de Urgencias Pediátricas.

OBJECTIVE: To determine management practices of minor head trauma in children evaluated at Spanish Hospital Emergency Departments and to determine patient variables associated with intracranial injury. METHODS: Multicenter and prospective study during 18 months in 9 hospitals in Spain. Patients up to the age of 18 years with minor head trauma (Glasgow Coma Scale score higher than or equal to 13 on admission), treated in Emergency Departments and with a maximum onset of 72h since the traumatism, were included in the study. RESULTS: A total of 1070 patients were studied with a median age of 2.4 years (p25-75 0.9-6.4 years); 61.2% were male. The median time between head trauma and medical consultation was 1 hour (p25-75 0.6-2.5h). Skull X-rays were performed on 64.5% of the children and a head CT scan on 9%; 91.4% of X-ray and 84.4% of CT were normal. The prevalence of intracranial injury was 1.4% (95% CI: 0.8-2.3). Twenty-five point three percent of the patients were admitted; 4 (3.7%) required neurosurgical intervention during admission. None of the patients died. Multiple logistic regression analysis identified loss of consciousness (OR 4.2, 95% CI: 1.1-17; P=0.045), neurological deterioration (OR 8.8, 95% CI: 2.1-37.6; P=0.003) and cephalhaematoma (OR 14.6, 95% CI: 4.9-44; P <0.001) as independent predictors of intracranial injury. CONCLUSIONS: The combination of clinical parameters allows selection of patients with minor head trauma who need complementary explorations. In consequence, the routine use of skull X-ray in their initial evaluation is unnecessary.

Publicaciones de los pediatras de Atención Primaria españoles en revistas científicas. 1999-2005 / No disponible

Objetivo: analizar la producción científica de los pediatras de Atención Primaria (PAP)como un medio de aproximación a su perfil investigador.Diseño: estudio descriptivo transversal.Fuentes de información: la información se recuperó en cinco etapas: 1) revisión, artículopor artículo, de revistas pediátricas y de Atención Primaria; 2) búsqueda de artículos combinadaMedline-Embase; 3) búsqueda por autor; 4) contacto personal con autores, y 5) contactocon informadores clave.Mediciones principales: se identificaron trabajos publicados por PAP y firmados desdeAtención Primaria. Para cada trabajo se valoró: autor, filiación, revista, tipo de publicación,temática y financiación.Resultados: en el período 1999-2005 se hallaron 565 trabajos firmados por 286 autores(primeros PAP firmantes), sobre 14.955 artículos evaluados. El 84,9% de los trabajos tenía alpropio PAP como primer autor.El 48,8% del conjunto de trabajos y el 70% de los originales estaban indexados por Medlineo Embase. Un total de 24 trabajos (4,2%) habían sido publicados en revistas de lengua inglesa.El 47,4% de los trabajos fue firmado de forma colaborativa. El 42,5% fueron originales,en general observacionales. Tres revistas (Pediatría de Atención Primaria, Anales de Pediatría yAtención Primaria) acumularon el 56% de los artículos. Asturias, La Rioja, Cantabria y Navarrason las comunidades con mayor tasa de publicaciones indexadas por 100 pediatras y año. Entérminos absolutos, las autonomías con más publicaciones son Madrid, Cataluña y Valencia.Los trabajos fueron catalogados en 45 áreas temáticas. Se identificaron 16 trabajos financiadospor agencias externas.Conclusiones:– Los pediatras españoles de Atención Primaria publican una media de 80 trabajos poraño (34 originales). – Sólo la mitad de los trabajos aparece indexada en Medline y/o Embase.– Hay una mayor tendencia a publicar los trabajos originales en revistas indexadas.– La presencia internacional es anecdótica

Objective: analyze the scientific production of Spanish primary care paediatricians (PAP)in order to a better knowledge of their researching profile.Methods: descriptive study of biomedical publications during 1999-2005, in five steps:1) review article by article of Spanish paediatric journals and primary care journals; 2) combinedMedline-Embase search; 3) search by author; 4) personal contact with authors, and 5)contact with key persons. Papers from PAP and signed from Primary Care were identified andauthor, institution, journal, type of publication, topics and funds were described.Results: papers identified were 565, signed by 286 authors (first PAP who signed), from14,955 evaluated articles. Most of them (84.9%) had the PAP as first author. The 48.8% of papersand 70% of original articles were indexed by Medline or Embase and 24 (4.2%) were publishedin English language journals. Four out of ten papers were signed in collaboration withother institutions. A total of 240 papers (42.5%) were original articles, observational studies ingeneral. Three journals gathered more than half papers (Rev Pediatr Aten Primaria, An Pediatrand Aten Primaria). Asturias, La Rioja, Cantabria and Navarra were the regions with better ratioof indexed publications by paediatrician and year. Overall, the regions with more number ofpublications were Madrid, Catalonia and Valencia. Papers were classified in 45 topics and werefound 16 papers supported with external funds.Conclusions: Spanish primary care paediatricians publish 80 papers per year (34 originals).– Only half oft he papers are indexed by Medline or Embase.– There is a trend to publish original papers in indexed journals.– Publication in English language journals is anecdotic