Actions to Avoid in Pain Management and Sedoanalgesia Procedures in Pediatric Emergencies.

OBJECTIVES: The aim of this study was to show the process of elaboration and the results obtained of the list of "do not do" recommendations for pain management and sedoanalgesia procedures in pediatric patients within the Working Group on Analgesia and Sedation of the Spanish Society of Pediatric Emergencies (Grupo de Trabajo de Analgesia y Sedación de la Sociedad Española de Urgencias de Pediatría [GTAS-SEUP]). METHODS: The process of drawing up the list was carried out in 3 phases: (1) "brainstorming," open to all members of the GTAS-SEUP; (2) selection of recommendations, after a modified Delphi methodology; and (3) drafting and consensus of the final document. RESULTS: Initially, 57 proposed recommendations were obtained, which were reduced to 39 by unifying those that were similar. Of the 14 "do not do" in pain management, 6 were accepted: 3 in the first round and 3 in the second round. Of the 25 "do not do" recommendations for sedoanalgesia procedures, 6 were accepted: 4 in the first round and 2 in the second round. The final text consisted of 12 actions to avoid, 6 referring to pain management and 6 to sedoanalgesia procedures. CONCLUSIONS: The list of "do not do" recommendations for pain management and sedoanalgesia procedures in the pediatric patient is a consensual tool, within the GTAS-SEUP. These recommendations promote an improvement in the quality of care offered to these patients, based on avoiding unnecessary measures, which can sometimes be harmful.

Blood analysis for screening of electrolyte and kidney function alterations in patients with febrile urinary tract infection.

AIM: To describe the prevalence, severity, risk factors, and clinical relevance of electrolyte disturbances and acute kidney injury (AKI) during febrile urinary tract infection (fUTI). METHODS: Retrospective observational study of well/fair-appearing patients between 2 months and 16 years, with no previous relevant medical history, diagnosed with fUTI in the paediatric emergency department (PED) with subsequent microbiological confirmation. Analytical alteration (AA) data were considered: AKI (creatinine elevation × 1.5 the median for age), plasma sodium alteration (≤130 or ≥150 mEq/L), and potassium alteration (≤3 or ≥6 mEq/L). RESULTS: We included 590 patients, 17.8% presented AA (13 hyponatremia, 7 hyperkalaemia, and 87 AKI). No patient presented severe analytic alterations or a higher frequency of symptoms potentially attributable to these alterations (seizures, irritability, or lethargy). Risk factors associated with these AA were clinical dehydration (OR = 3.5 95% CI: 1.04-11.7; p = 0.044) and presenting a temperature >39°C (OR = 1.9 95% CI: 1.14-3.1; p = 0.013). CONCLUSIONS: Electrolyte and renal function disturbances are infrequent in the previously healthy paediatric population with a fUTI. If present, they are asymptomatic and not severe. Based on our results, performing systematic blood analysis to rule out AA appears no longer justified, especially in the absence of risk factors.

Characteristics of Upper Limb Osteoarticular Infections at the Emergency Department of a Tertiary University Hospital in Spain.

OBJECTIVES: Osteoarticular infections are infrequent in pediatric patients, although their incidence seems to be increasing. They usually affect children younger than 5 years and tend to localize in the lower limbs. Because of their nonspecific symptoms, especially at onset, a timely diagnosis is difficult to achieve, with the subsequent risk of a delay in treatment. We hereby report the management of osteoarticular infections in our pediatric emergency department. METHODS: This is a retrospective descriptive study of patients diagnosed with osteoarticular upper limb infection in the pediatric emergency department of a tertiary hospital from January 2011 to December 2016. RESULTS: From an initial global sample of 170 patients diagnosed with osteomyelitis or septic arthritis at any location at the pediatric emergency department, 32 children (18.82%) with upper limb involvement were included in the study. Of them, 22 were male and the mean age at diagnosis was 14.5 months (interquartile range, 2-106). Eighteen patients (56%) were diagnosed with septic arthritis, and 14 (44%) had a diagnosis of osteomyelitis.The most frequent symptom was pain (50%). More than one third of patients (11) had received a different diagnosis in a previous hospital visit. A traumatic etiology was suspected in 7 cases (21%).Regarding acute phase reactants, the mean value for C-reactive protein was 21.3 mg/L, and erythrocyte sedimentation rate was elevated in 27 cases (84%). In 28 patients, blood cultures were obtained, 24 of which came back negative. All children received antibiotic treatment and achieved a full recovery. CONCLUSIONS: One third of patients were misdiagnosed at the first consultation, which stresses the importance of a high clinical suspicion to avoid delays in diagnosis and treatment of osteoarticular infections. This study also shows a lower mean age of children with upper limb infection as compared with those with lower limb infection. All patients recovered fully with oral antibiotics.

Comparación entre la primera y la segunda ola de la pandemia producida por el coronavirus SARS-CoV-2 en urgencias pediátricas de un hospital terciario de Madrid / Comparison between patients attended in the emergency department of a tertiary hospital in Madrid in the first and second wave of coronavirus SARS-COV-2 pandemic

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Impacto del desconfinamiento por la pandemia por COVID-19 sobre el patrón de traumatismos observados en un servicio de urgencias / Impact of deconfinement due to the COVID-19 pandemic on the trauma pattern observed in an emergency department

Introducción: después de 42 días de confinamiento decretado por la situación de pandemia mundial por la COVID-19, se permitió la salida de los domicilios a los menores de 14 años. El objetivo de este estudio fue analizar el impacto de este periodo de desconfinamiento en el perfil de accidentes traumatológicos en niños. Material y métodos: se llevó a cabo un estudio observacional retrospectivo de los menores de 16 años atendidos en Urgencias de un hospital terciario por traumatismo entre el 26 de abril de 2020 y el inicio de la desescalada en la Comunidad de Madrid el día 24 de mayo del mismo año. Se comparó el número de traumatismos, las fracturas, el mecanismo de acción y la localización, entre otros, con respecto al mismo periodo del año anterior. Resultados: se observó un aumento significativo en el porcentaje de fracturas respecto al año 2019 (41,9 frente al 11,3%; p <0,001). El porcentaje de accidentes secundarios a vehículos con ruedas (43,9 frente al 6,2%; p <0,001) fue significativamente superior durante 2020, siendo los asociados a bicicleta (35,4%) y patinete (32,2%) los más frecuentes. Conclusiones: durante el periodo de desconfinamiento, se ha producido un notable incremento de los accidentes provocados por vehículos con ruedas en la población infantil, aunque esta observación probablemente esté influida por las medidas organizativas específicas puestas en marcha en Madrid en el periodo de tiempo estudiado (AU)

Introduction: after 42 days of lockdojavascript:void(Set_Locked(0,'GRAVA REGISTRO/COMPLEMENTO.x'))wn imposed due to the global COVID-19 pandemic, children under 14 years were allowed to leave their homes. The aim of the study was to analyse the impact of the period following the lifting of confinement measures on traumatic injury trends in children.Material and methods: we carried out a retrospective and observational study in children aged less than 16 years that presented with traumatic injuries to the emergency department of a tertiary care hospital between April 26 and the start of the scaling down in the Community of Madrid on May 24. We compared the frequency of traumatic injuries and fractures, the mechanism and site of injury and other variables to those recorded in the same period the year before.Results: there was a significant increase in the proportion of fractures compared to 2019 (41.9 vs. 11.3%; p <0.001). The percentage of accidents related to wheeled vehicles was significantly higher in 2020 (43.9 vs. 6.2%; p <0.001), with these accidents most frequently involving bicycles (35.4%) and scooters (32.2%).Conclusions: in the period following the lockdown, there was a remarkable increase in accidents related to wheeled vehicles in the paediatric population, although this outcome was probably influenced by specific organizational measures implemented in Madrid in the period under study. (AU)

Neumonías adquiridas en la comunidad por Staphylococcus aureus resistente a meticilina en lactantes / Methicillin-resistant Staphylococcus aureus community-acquired pneumonia in infants

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