Procalcitonin as Point-of-Care Testing Modality for the Diagnosis of Pneumonia in Children With Influenza-like Illness.

OBJECTIVE: To evaluate the usefulness of procalcitonin (PCT) as a point-of-care testing to screen for radiographic pneumonia among children with influenza-like illness (ILI) and prolonged fever. METHODS: A prospective cohort study conducted at the pediatric emergency department of a tertiary hospital. Point-of-care testing for PCT was determined for 185 children aged 3 months to < 18 years with ILI and fever lasting > 4 days seen during the flu season in 2020. A chest radiograph (CXR) was performed for patients with PCT > 0.5 ng/mL. RESULTS: PCT value was > 0.5 ng/mL in 46 (24.9%) patients; a CXR was ordered in all cases except one and 14 (31.1%) of them had radiographic pneumonia (all had a PCT value > 0.7 ng/mL). Among the 139 (75.1%) patients with a PCT value ≤ 0.5 ng/mL, 137 (98.6%) were managed in the outpatient with symptomatic treatment; the remaining two cases warranted a CXR which was unremarkable in both. At evolution, no radiographic pneumonia was diagnosted in any of them. CONCLUSION: PCT is a useful tool for point-of-care testing in patients with ILI and fever > 4 days to guide the indication for CXR to rule out radiographic pneumonia and helps in avoiding unnecessary radiation exposure.

Bacterial coinfection in young febrile infants with SARS-CoV-2 infection.

We aimed to assess the prevalence of serious bacterial infections (SBIs) in febrile infants < 90 days of age with SARS-CoV-2 infection versus SARS-CoV-2-negative febrile infants. A retrospective cohort study was conducted in a tertiary pediatric emergency department between March 2020 and October 2022. Febrile infants < 90 days of age who underwent SARS-CoV-2 testing were included. SBIs were defined as urinary tract infection (UTI), bacteremia, and/or bacterial meningitis; bacteremia and bacterial meningitis were considered invasive bacterial infections (IBIs). SBIs rates were compared between SARS-CoV-2-positive and negative infants and stratified by age. We included 779 infants: 221 (28.4%) SARS-CoV-2-positive and 558 (71.6%) SARS-CoV-2-negative. The SBI rate in the SARS-CoV-2-positive group was 5.9% vs 22.9% in the SARS-CoV-2-negative group (p < 0.001; relative risk (RR) 0.26; [95% CI 0.15-0.44]); the most common infections were UTI (5.4% vs 22.0%; p < 0.001). The IBI rate was 0.5% in the SARS-CoV-2-positive group vs. 3.2% in the negative group (p = 0.024; RR 0.14 [95% CI 0.02-1.04]). There were no cases of bacterial meningitis in the positive infants. SARS-CoV-2-positive infants > 28 days of age had a decreased likelihood of SBI (RR 0.22 [95% CI 0.11-0.43]), with no cases of IBI identified.     Conclusions: Febrile infants < 90 days of age with SARS-CoV-2 infection are at significantly lower risk of SBIs than those who are SARS-CoV-2-negative. Nevertheless, the rate of UTI remains considerable in SARS-CoV-2-positive infants. SARS-CoV-2 detection may be relevant in considering IBI risk for well-appearing febrile infants 29-89 days of age. What is Known: • Febrile infants with laboratory-confirmed viral infections have a significantly lower risk of serious bacterial infections when compared to those without them. Data focusing on very young febrile infants with a SARS-CoV-2 infection is still limited. What is New: • Young febrile infants with SARS-CoV-2 infection are at significantly lower risk of serious bacterial infections than those who are SARS-CoV-2-negative. Nevertheless, the rate of urinary tract infection remains considerable. SARS-CoV-2 detection may be relevant in considering invasive bacterial infection risk for well-appearing febrile infants 29-89 days of age.

New-onset type 1 diabetes mellitus in the Paediatric Emergency Department: impact of the COVID-19 pandemic.

PURPOSE: On the 14th of March 2020, the Spanish government decreed a state of alarm due to the coronavirus disease 2019 (COVID-19) pandemic, directly affecting healthcare. This situation led to delayed diagnosis of several serious diseases, and its impact on many diseases such as the onset of type 1 diabetes mellitus (T1DM) remains unknown. The aim of this study is to determine the impact of the COVID-19 pandemic on the onset of T1DM in children. METHODS: A descriptive-observational study was performed using data from children younger than 18 years (n=115) admitted with diagnosis of T1DM. We compared the 8 months from May-December 2020 to the same timeframe in 2019. RESULTS: Our data show an increase of newly attended cases of T1DM in 2020, due to referral of Catalan children with onset of diabetes to our centre. Moreover, fewer patients presented with simple hyperglycaemia at the onset of the COVID-19 period. Delay in consulting the hospital, decreased access to the healthcare system, and avoidance of hospitals to minimize exposure to COVID-19 could have contributed to this finding. There were no differences in the number of days of hospitalization (including days in the paediatric intensive care uniy) between the years. CONCLUSION: The effects of the lockdown during the COVID-19 pandemic not only delayed the diagnosis of diabetes, but also its allowed time for its severity to increase. Future studies should focus on the influence of new variants of COVID-19 on the onset of T1DM during the postvaccination period.

Retinal hemorrhages due to intracranial hypertension, is it possible to differentiate them from those associated with abuse?

BACKGROUND: Retinal hemorrhages (RHs) are suggestive of abusive head trauma (AHT). Even so, controversy persists about other possible causes, a fact that hinders the diagnosis of abuse. OBJECTIVE: To determine the prevalence and patterns of RHs associated with increased intracranial pressure (ICP) in young children. PARTICIPANTS AND METHODS: Prospective, single center study of children aged 29 days-3 years undergoing a lumbar puncture with opening pressure (OP) measured during routine clinical care in the emergency department, over a 4-year period. Children with known causes of RHs were excluded. All the children underwent a detailed ophthalmological examination within 72 h of admission. For children with RHs, an in-depth investigation was carried out to rule out AHT. RESULTS: Thirty-four patients were included: 20(58.8 %) were boys, median age 11.7 months (range 1-33 months). Overall, 29(85.3 %) had clinical findings of increased ICP. The duration of symptoms was ≤4 days in all patients except one, in whom it was 1.5 months. The median OP was 27cmH2O (range 20-60cmH2O). One of the children was found to have RHs, with evaluation resulting in a diagnosis of AHT. No RHs were found in any of the others studied. Using the Wilson method, we can be confident to an upper limit of 95 % that the probability of RHs occurring secondary to increased ICP alone is at most 0.1. CONCLUSIONS: RHs were not detected in patients with isolated nontraumatic increased ICP, measured via OP and diagnosed in the ED. Therefore, if RHs are detected, investigation into the possibility of AHT is warranted.

Presència dels familiars al box de crítics dels serveis d’urgències / Presencia de los familiares en el box de críticos de los servicios de urgencias / Family presence in the resuscitation room of pediatric emergency departments

Fonament. La presència dels familiars és cada cop més habitual als serveis d’urgències pediàtriques (SUP), on participen activament en la presa de decisions, els tractamentsi les cures del pacient.Objectiu. 1) Conèixer la proporció de SUP catalans en quèla presència dels familiars és habitual als boxs de crítics ien quines condicions. 2) Descriure els problemes que se’nderiven.Mètode. Estudi descriptiu multicèntric. Se sol·licita als responsables dels SUP que complimentin una enquesta sobrela presència de familiars als boxs de crítics (protocol, ubicació, acompanyament dels familiars, problemes derivats).Resultats. S’envien divuit enquestes, i s’obtenen setze respostes (taxa de resposta 88,8%) d’hospitals de mitjana(12/16) i alta (4/16) complexitat. Tots els SUP disposen debox de crítics i en 15/16 s’ofereix als familiars ser-hi presents durant l’atenció de l’infant; en un SUP no s’ofereixaquesta opció perquè l’espai és reduït, malgrat que la troben necessària. Dos SUP disposen de protocol. Durantl’atenció al pacient greu, els familiars estan acompanyatsper algun sanitari (11/16), però intermitentment (7/16). Espermeten un o dos familiars, sempre que ho desitgin(13/16) o després de l’estabilització inicial (2/16). Dos responsables manifesten problemes derivats, com el nerviosisme i l’agressivitat familiar.Conclusions. La presència de familiars als boxs de crítics éshabitual als SUP enquestats, sense problemes destacables.No obstant això, s’han detectat alguns aspectes millorables(elaboració de protocols i acompanyament dels familiars). (AU)

Fundamento. La presencia de familiares es cada vez más habitualen los servicios de urgencias pediátricas (SUP), colaborando en latoma de decisiones, tratamientos y cuidados del paciente. Objetivo. 1) Conocer la proporción de SUP catalanes en los que lapresencia de familiares es habitual en el box de críticos y en quécondiciones. 2) Describir problemas derivados.Método. Estudio descriptivo multicéntrico. Se solicita a los responsables de los SUP cumplimentar una encuesta sobre la presenciade familiares en el box de críticos (protocolo, ubicación, acompañamiento de los familiares, problemas derivados).Resultados. Se envían 18 encuestas y se obtienen 16 respuestas(tasa de respuesta (88,8%) de hospitales de mediana (12/16) yalta (4/16) complejidad. Todos los SUP disponen de box de críticos y en 15/16 se ofrece la presencia de familiares durante laatención del paciente crítico, en uno de ellos no está permitida porespacio reducido, pero la consideran necesaria. Dos SUP disponende protocolo. Los familiares están acompañados por algún profesional sanitario (11/16), pero de manera intermitente (7/16). Sepermiten 1 o 2 familiares, siempre que lo deseen (13/16) o después de la estabilización inicial (2/16). Dos responsables notificanproblemas puntuales (nerviosismo y agresividad familiar).Conclusiones. La presencia de familiares en los boxes de críticoses habitual en los SUP participantes, sin problemas destacables.Se han detectado algunos aspectos de mejora (elaboración de protocolos y acompañamiento de los familiares). (AU)

Background. Family presence is common in pediatric emergencydepartments (PED), and relatives actively collaborate in decisionmaking, treatment, and patient care.Objective. 1) To identify the proportion of Catalan PED where family presence is allowed in the resuscitation room and to describethe characteristics of family presence. 2) To describe the problemsthat arise from the presence of family members.Method. A multicenter descriptive study was designed. Chiefphysicians of PED were asked to participate via email in a surveyasking about the PED characteristics and the family presence inthe resuscitation room (protocol, location, relatives’ companion,problems).Results. 18 surveys were sent, obtaining 16 responses (responserate 88.8%) from middle (12/16) and high (4/16) complexity hospitals. All the PED have a resuscitation room, and family presence is offered in 15 of them (in one hospital family presence is notallowed because of limited space). 2 PEDs have a written protocolabout family presence in the resuscitation room. Family membersare accompanied by a healthcare worker (11/16), but not continuously (7/16). One or two relatives are usually allowed to be present in the resuscitation room, for as long as they desire (13/16)or after initial stabilization (2/16). Two chief physicians reportedoccasional problems (family anxiety and aggressivity).Conclusions. Family presence in the resuscitation room is commonin Catalan PED, without significant related problems. However,some aspects should be improved, particularly related to writtenprotocols and accompaniment of family members. (AU)

New multivariable prediction model PEdiatric SEpsis recognition and stratification (PESERS score) shows excellent discriminatory capacity.

AIM: To develop a quantitative predictive scoring model for the early recognition and assessment of paediatric sepsis. METHODS: Prospective observational study including emergency department and in-hospital febrile patients under 18 years. Sepsis diagnose (Goldstein 2005 definitions) was the main outcome. Variables associated with the outcome were included in a multivariable analysis. Cut-off points, odds ratio and coefficients for the variables kept after the multivariable analysis were identified. The score was obtained from the coefficients, The AUC was obtained from ROC-analysis, and internal validation was performed using k-fold cross-validation. RESULTS: The analysis included 210 patients. 45 variables were evaluated and the bivariate analysis identified 24 variables associated with the outcome. After the multivariable regression, 11 variables were kept and the score was obtained. The model yielded an excellent AUC of 0.886 (95% CI 0.845-0.927), p < 0.001 for sepsis recognition. With a cut-off value of 5 for the score, we obtained a sensitivity of 98%, specificity of 76.7%, positive predictive value of 87.9% and negative predictive value of 93.3%. CONCLUSION: The proposed scoring model for paediatric sepsis showed adequate discriminatory capacity and sufficient accuracy, which is of great clinical significance in detecting sepsis early and predicting its severity. Nevertheless external validation is needed before clinical use.

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.

Outpatient and oral management is suitable for infants 60-90 days old with urinary tract infections at low risk of bacteremia.

One previous study recommended oral and outpatient management for those infants aged 60-90 days with urinary tract infection (UTI) meeting the low-risk criteria identified: to be well-appearing and to have a procalcitonin value of < 0.7 ng/mL. A retrospective study was conducted, including infants aged 29 to 90 days with UTI from 2014 to 2019, to validate these low-risk criteria identified and determine the adherence to the new algorithm for managing these patients at the Emergency Department. Two hundred one patients were included; 105 (52.2%) were aged 60 to 90 days. Twelve (6%, 95% CI 3.4-10.1%) had bacteremia. One hundred thirty-six (67.7%) infants met low-risk criteria; none had a positive blood culture (0%, 95% CI 0-2.7%). Overall protocol adherence was 90.6%. One hundred and forty-four (71.6%) infants were admitted to the hospital; all patients meeting high-risk criteria were hospitalized. Among the 57 (28.4%) infants initially sent home, 4 (7.0%) required later hospital admission.Conclusions: A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants. What is Known: • Patients under 2-3 months of age with a presumptive urinary tract infection (UTI) are commonly hospitalized because of concerns regarding concomitant bacteremia. What is New: • A prediction rule including general appearance and procalcitonin is highly accurate in identifying young infants with UTI at low risk for bacteremia. Outpatient management with appropriate follow-up is safe for these infants.

Neonates With Urinary Tract Infection: Is a Lumbar Puncture Always Indicated?

BACKGROUND: Our objectives were to determine the prevalence of and to identify risk factors for coexisting bacterial meningitis (BM) in neonates with urinary tract infection (UTI). METHODS: A cross-sectional study was conducted at pediatric emergency department of a tertiary teaching hospital from 2001 to 2017. Infants <29 days of age with UTI (≥10,000 colony-forming units/mL of a single pathogen from a catheterized specimen in association with positive urinalysis) were included. Definite BM was defined as growth of a single bacterial pathogen from a cerebrospinal fluid (CSF) sample and probable BM as (1) positive blood culture with CSF pleocytosis and treatment consistent with BM or (2) antibiotic pretreatment before lumbar puncture, CSF pleocytosis and treatment consistent with BM. Univariate testing was used to identify possible risk factors associated with BM. Receiver operating characteristics curves were constructed for the laboratory markers associated with BM. RESULTS: Three hundred seventy-one infants were included. Five [1.3%; 95% confidence interval (CI): 0.6%-3.1%] had BM: 4 definite BM and 1 probable BM. Risk factors detected for BM were classified as not being well-appearing and a procalcitonin value ≥0.35 ng/mL [sensitivity of 100% (95% CI: 56.6%-100%) and negative predictive value of 100% (95% CI: 96.1%-100%)]. CONCLUSIONS: Coexisting BM occurs uncommonly in neonates with UTI. Well-appearing neonates with UTI and procalcitonin value <0.35 ng/mL were at very low risk for BM; avoiding routine lumbar puncture in these patients should be considered.

Antibiotic Prescription Quality in Group A b-hemolytic Streptococcal Pharyngitis.

Antibiotic prescriptions in 227 patients with acute group A b-hemolytic streptococcal pharyngitis in the emergency department were studied. Antibiotic prescription was inappropriate in 42% of the cases, especially due to errors in the prescription of amoxicillin. Probably the use of low-spectrum penicillins would improve this percentage.

Patient Experience in a Spanish Pediatric Emergency Department.

OBJECTIVES: To study the experience reported by pediatric patients when visiting a pediatric emergency department (PED). METHODS: This was a prospective descriptive study, carried out in November 2014. A 12-question survey was developed, based on the Picker Patient Experience Questionnaire. The aim was to assess patient experience of children between 8 and 18 years old, attended in the PED of a high-complexity pediatric hospital. Questions were about the waiting time and setting, medical staff explanations and actions, treatment, and discharge. The questionnaires were administered and filled in by the children themselves at discharge. RESULTS: One-hundred seventy questionnaires were completed; 17.1% of respondents had to wait longer than expected, and 44.7% said that there was not enough to do when waiting to be seen. Pain was not correctly treated (3%), there was a lack of privacy (14.7%), and the information provided to the patients during the visit was wanting (10%). However, 80% said that they had been well treated. CONCLUSIONS: The patient experience of children in our PED was positive, although some aspects should be improved such as offering entertainment in the waiting area, increasing privacy during the medical visit, and giving better explanations to the children.

Epidemiology of Fractures in Children Younger Than 12 Months.

OBJECTIVES: The aim of this study is to determine the prevalence and characteristics of fractures in young infants attended at the pediatric emergency department (PED). METHODS: This is a retrospective study for 2 years (2011-2012) of children younger than 12 months attended with a fracture at the PED. Age, sex, site and type of fracture, mechanism of injury, time interval before seeking medical attention, and management were analyzed. RESULTS: One hundred one patients were included. They represented 0.3% (95% confidence interval, 0.2%-0.4%) of all children younger than 12 months attended at the PED. The median age was 7.7 months (interquartile range, 5.2-10.1 months); 58 (57.4%) were boys. The most common fracture was skull fracture (58, 57.4%), mostly parietal, followed by long bone fractures (27, 26.7%); transverse and torus fractures were the most common types, located at the diaphysis and distal metaphysis, respectively. The principal mechanism reported was falling (83, 82.2%) mainly from furniture. Fifty-one patients (50.1%) were attended in the first 6 hours after injury. Sixty-five patients (64.4%) were admitted at the hospital and the other 9 (8.9%) were controlled in outpatient visits. One of them was injured because of negligence and another was diagnosed with osteoporosis. CONCLUSIONS: Fractures in young infants are uncommon at the PED, the skull fracture being the most common. Pediatricians should alert caretakers of the risks in normal development to prevent these injuries. Fractures caused by child abuse should always be discarded.

Parent experience in the resuscitation room: how do they feel?

The aim of this study is to describe the experience of parents present in the resuscitation room during the attention given to their children in the pediatric emergency department, and to identify areas for improvement in this regard. This was a prospective study carried out in a third-level pediatric hospital. Children with life-threatening pathologies are treated in the resuscitation room of the pediatric emergency department. A survey was carried out among parents present in the resuscitation room during the period September 2016-August 2017. Excluded were the parents of children that died and those with a language barrier. The parents were interviewed in person or over the phone within 72 h of the care provided in the resuscitation room. Fifty surveys were completed (15 in person and 35 by phone). Forty mothers and 10 fathers responded, with an average age of 41. In the resuscitation room, 39 parents were accompanied by a health professional and 22 were given information about how the resuscitation room operated. The feelings most frequently reported by the parents were nervousness (39) and trust in the healthcare provided (20). All of the parents wished to be present. They felt that their presence was beneficial for the child (46), for themselves (50), and for the healthcare personnel (28).Conclusion: The experience of the parents in our resuscitation room is a positive one. Nevertheless, some aspects need to be improved, such as accompaniment of the parents and the information that they are provided. What is Known: • There is an international recommendation for parental presence during invasive procedures and cardiopulmonary resuscitation. • Few studies have been carried out on how parents in the resuscitation room feel and how they encounter the experience. What is New: • Even though most of the parents feel nervous in the resuscitation room, they expressed confidence in the medical team and they would wish to be present under similar circumstances.

Patient experience in the pediatric emergency department: do parents and children feel the same?

The objectives are to describe the experience of children and parents in a pediatric emergency service (PED) and to determine whether there are differences of opinion between the two groups. This was a descriptive study. A questionnaire was designed based on the Picker questionnaire on the patient experience. From July through December 2015, a survey was made of the children aged 8-18 treated in the PED, as well as of their parents. The proportion of dissatisfaction was determined. A total of 514 questionnaires (257 children, 257 parents) were completed. The most poorly rated aspects according to the children and parents were the entertainment activities (43.2%), the waiting time (23.7%), and the treatment for pain (10.5%). Differences were detected in the experiences of the children and the parents regarding the overlong waiting time (28.0% children vs 19.5% parents; p = 0.023), inadequate explanations (7.0 vs 1.6%, p = 0.002), inadequate treatment for pain (14.4 vs 6.6%; p = 0.004), and insufficient privacy (11.7 vs 2.7%; p < 0.001). CONCLUSION: The entertainment activities during the wait and the waiting time are the two elements viewed most negatively by the children and the parents. The children tend to evaluate certain aspects of their experience as patients more negatively, which needs to be borne in mind in order to improve the attention provided. What is Known: • Studying the experience of patients is a key point in patient-centered medicine. • The experience of the pediatric patient has been little studied to date. The experience of the children is often inferred from that of their parents. Nevertheless, the experience of the children as patients might be different. What is New: • Overall, the experience of children and parents in the pediatric emergency department in the study is positive. Some aspects of the experience in emergency are poorly rated by the children, such as the waiting time, the information provided, treatment for pain, and privacy during the visit. • The experience of the children (and not merely that of their parents) needs to be studied in order to improve those areas that are rated poorly do as to enrich the experience in the emergency department.

Factors assistencials relacionats amb la percepció de saturació a urgències: opinió dels professionals / Saturación en Urgencias: opinión de los profesionales / Health delivery factors associated with the perception of saturation of emergency care services: the opinion of the professionals

Fonament: la saturació a urgències comporta conseqüències negatives sobre la qualitat assistencial. És important saber quins factors de l'assistència en relació amb la saturació preocupen més el personal sanitari amb la finalitat de corregir-los. Objectiu: conèixer la importància dels factors de l'assistència relacionats amb la saturació a urgències segons la percepció dels professionals. Mètode: estudi descriptiu. Durant la primera setmana de ju-liol del 2014, s'administra una enquesta anònima al personal d'urgències. L'enquesta valora diferents aspectes sobre la saturació en aquest departament. Consta de dues parts: en la primera es valoren dotze variables numèriques i cinc de temps, en escala d'importància de l'1 al 10; i en la segona es dona un valor quantitatiu als ítems més rellevants. Resultats: es recullen 51 enquestes, 29 d'infermeria i 22 de pediatres. Els tres ítems més rellevants en la primera part corresponen a: nombre de pacients de nivell II-III pendents de visitar (mitjana 9,3; IC 95%: 9,1-9,5), temps d'espera dels pacients de nivell II-III fins a ser atesos (mitjana 9,3; IC95%: 9,0-9,5) i nombre de procediments d'infermeria pendents (mitjana 8,2; IC95%: 7,7-8,7). Respecte a aquests ítems, de mediana, els professionals consideren normal que hi hagi tres pacients pendents de ser visitats, amb un temps d'espera de deu minuts i tres procediments per fer. A partir de deu pacients, quaranta minuts i set procediments, es creu que les urgències estan saturades. Conclusions: la quantitat de pacients de nivell II-III pendents de ser visitats i el seu temps d'espera, junt amb la càrrega de treball d'infermeria, són els aspectes que influeixen més en la percepció de saturació a urgències

Fundamento. La saturación en urgencias conlleva consecuencias negativas sobre la calidad asistencial. Es importante saber qué factores de la asistencia en relación a la saturación preocupan más al personal sanitario con la finalidad de corregirlos. Objetivo. Conocer la importancia de los factores de la asistencia relacionados con la saturación en urgencias según la percepción de los profesionales. Método. Estudio descriptivo. Durante la primera semana de julio de 2014, se administra una encuesta anónima al personal de urgencias. La encuesta valora diferentes aspectos sobre la saturación en urgencias. Consta de dos partes, en la primera se valoran doce variables numéricas y cinco de tiempo, en escala de importancia del 1 al 10, y en la segunda se da un valor cuantitativo a los tres ítems más relevantes. Resultados. Se recogen 51 encuestas, 29 de enfermería y 22 de pediatras. Las tres puntuaciones más altas en la primera parte de la encuesta corresponden a: número de pacientes de nivel II-III pendientes de visitar (9,3; IC95%: 9,1-9,5), tiempo de espera de los pacientes de nivel II-III hasta ser atendidos (9,3; IC95%: 9,0- 9,5) y número de procedimientos de enfermería pendientes (8,2; IC95%: 7,7-8,7). Respecto a estos ítems, de mediana, los profesionales consideran que es normal que haya tres pacientes pendientes de ser visitados, con un tiempo de espera de diez minutos y tres procedimientos por hacer. A partir de diez pacientes, cuarenta minutos y siete procedimientos, se cree que las urgencias están saturadas. Conclusiones. La cantidad de pacientes de nivel II-III pendientes de ser visitados y su tiempo de espera, junto con la carga de trabajo de enfermería, son los aspectos que más influyen en la percepción de saturación en urgencias (AU)

Background. Overcrowding in the emergency department (ED) has a negative impact on the quality of the care delivered. Thus, it is important to identify and address the factors associated with overcrowding that are of most concern to the providers. Objective. To ascertain the healthcare delivery factors associated with overcrowding that are of most concern to the providers. Method. Descriptive study. During the first week of July 2014, an anonymous questionnaire was distributed among the ED staff. The questionnaire evaluated different aspects related to overcrowding in the ED, and it comprised two parts. In the first part 12 numeric variables and 5 time variables were assessed, with an importance scale of 1 to 10; the second part was based on quantification of the three most important items from part 1. Results. Fifty-one questionnaires were completed, 29 from nurses and 22 from pediatricians. The three highest scores in the first part corresponded to number of patients of level II-III in waiting list (9.3; 95%CI:9.1-9.5), wait time for level II-III patients (9.3; 95%CI:9. 0-9.5), and the number of outstanding nursing procedures (8.2; 95%CI:7.7-8.7). In reference to those factors, the parameters considered normal by the providers were a median of three patients pending a visit, with a waiting time of 10 minutes, and 3 nursing procedures pending to be performed. An excess of 10 patients in waiting list, more than 40 minutes of waiting time, and more than 7 nursing procedures pending were considered ED overcrowding. Conclusions. The number of level II-III patients waiting to be seen and the waiting time, along with the nursing workload are the most important defining parameters that affect the perception of ED overcrowding by providers (AU)

Blood Cultures Are Not Useful in the Evaluation of Children with Uncomplicated Superficial Skin and Soft Tissue Infections.

BACKGROUND: Blood cultures (BCs) are commonly performed on children admitted to hospital for skin and soft tissue infections (SSTIs). In recent years, this practice has been questioned in patients with uncomplicated SSTIs because of its low yield. At the same time, however, an increase in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections has been described; its influence on rates of bacteremia in patients with SSTIs is unclear. The aims of the study were to describe the performance and the yield of BC in immunocompetent patients with uncomplicated SSTIs and to determine the prevalence of CA-MRSA as a causative agent in our area. METHODS: Retrospective study: immunocompetent patients younger than 18 years evaluated in the emergency department and admitted for uncomplicated SSTIs (cellulitis, abscess, impetigo or erysipelas) from July 1, 2010 to June 31, 2014 were included. Patients referred from other hospitals who were receiving parenteral antibiotics and patients with complicated SSTIs (surgical or traumatic wound infection, need for surgical intervention and infected ulcers or burns) were excluded. RESULTS: We included 445 cases: 348 (78.2%) cellulitis, 78 (17.5%) abscess and 19 (4.3%) impetigo. BCs were performed on 353 (79.3%) patients. Two (0.6%; 95% confidence interval: 0.2-2.0%) were positive and 10 (2.8%; 95% confidence interval: 1.5-5.1%) contaminated. The positive BCs grew S. aureus and Streptococcus pyogenes. Wound cultures were performed on 148 (33.3%) patients; 98 (66.2%) were positive. In 22 (22.4%) patients CA-MRSA grew, accounting for 14.9% of overall wound cultures. CONCLUSIONS: BCs are not useful in the management of immunocompetent patients admitted to the hospital with uncomplicated SSTIs. The prevalence of CA-MRSA is low in our area, but continuing careful surveillance is needed.

Clinical characteristics and molecular epidemiology of Enterovirus infection in infants <3 months in a referral paediatric hospital of Barcelona.

UNLABELLED: Enterovirus (EV) infection is common in infants, but the information with regard to the molecular epidemiology and the associations between types and clinical variables is very scarce. This study includes 195 children <3 months old with fever, attended from March 2010 to December 2012 in an emergency department of a tertiary paediatric hospital in whom EV infection was confirmed by real-time PCR in blood and/or cerebrospinal fluid. Clinical and epidemiological data was prospectively collected. In 152 (77.9 %) patients, EVs could be typed. The most common type was Echovirus-5 (E5; 32, 21.1 %), followed by Echovirus-11 (E11; 18, 11.8 %), Echovirus-21 and Echovirus-25 (E21, E25; 11 each one, 7.2 %) and Coxsackievirus-B4 (CVB4; 6, 6.6 %). The majority of types appeared in spring, but E5 and E25 were found mainly during summer (p < 0.01). E21 was associated with high-grade fever (p < 0.01); E5 with exanthema (p = 0.03) and CVB4 tended to cause meningitis more often than the other types (p = 0.07). CONCLUSION: The most common EV types were Echovirus-5 and Echovirus-11. Some significant associations between types and epidemiologic and clinical findings were observed. What is Known-What is New • Enteroviruses cause a normally benign illness in young infants, except in some cases. • The molecular epidemiology of Enterovirus infection is not well known in European countries. • This study describes a large number of infants with Enterovirus infection and shows the seasonality of different types, and their associations with epidemiologic and clinical variables.