[Bicycle accidents treated in emergency departments. A multicentre study]. / Accidentes de bicicleta atendidos en los Servicios de Urgencias. Estudio multicéntrico.

OBJECTIVES: To describe epidemiological characteristics, types of injury, prognosis and medical management of bicycle-related Paediatric Emergency Department (ED) visits and to identify potential preventive measures. PATIENTS AND METHODS: This multicentred, observational prospective study included all children between 3 and 16 years of age treated for bicycle-related injuries in the Emergency Departments of 15 Spanish Hospitals belonging to the «Unintentional Paediatric Injury Workshop¼ of the Spanish Paediatric Emergency Society between the 1(st) of June 2011 and the 31(st) of May 2012. Characteristics of all ED visits, as well as epidemiological data and accident-related information, were collected. RESULTS: A total of 846 patients were included in the study, with a male predominance (72.9%) and a median age of 9.6 ± 3.6 years. Head injury was the third most common injury (22.3%) and the main cause of admission to the Pediatric Intensive Care Unit (PICU) (68.4%). More than three-quarters (77.9%) of the patients did not wear a helmet, which was significantly associated to a higher incidence of head injury and admission to PICU. Older children (OR 1.063) and bicycle injuries involving motor vehicles (OR 2.431) were identified as independent risk factors for worse outcomes. CONCLUSIONS: Since helmet use reduces up to 88% of central nervous system lesions secondary to head injury, promotion of its use should be the main preventive measure, followed by restriction of bike-riding to cycling areas.

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.

Masa supraclavicular / Supraclavicular mass

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