Evolución de los ingresos por maltrato infantil durante 15 años / Hospital admissions due to child maltreatment over a fifteen year period

Objetivo: Determinar la evolución de la incidencia de ingresos por maltrato entre 1995 y 2009 y describir sus principales características clínicas y epidemiológicas. Métodos: Estudio retrospectivo de los niños con diagnóstico de alta de maltrato durante 15 años en un hospital de tercer nivel. Resultados: Se incluyen 97casos (incidencia mediana: 0,5 maltratos por 1.000 niños ingresados y año). Aumentan los ingresos por maltrato físico y disminuyen los de abuso sexual. Cincuenta y uno (53,6%) eran se sexo femenino; edad mediana 3.3 años (p25-75: 7,6 meses-10,0 años). El motivo de consulta no estaba relacionado con maltrato en 42 (43,3%) casos. Los hematomas (43; 44,3%) fueron las lesiones más frecuentes. En 91 (93,8%) casos el agresor fue un familiar (77; 74,9%, uno o ambos padres). Conclusiones: El aumento de ingresos por maltrato físico hace necesario insistir en políticas de prevención. La disminución en los casos de abusos sexuales probablemente sea más por cambios en los circuitos de atención a las víctimas que por una disminución real. En casi la mitad de los casos la sospecha surgió tras el examen físico o ante resultados de pruebas complementarias, siendo aconsejable tener presente el maltrato en el diagnóstico diferencial de múltiples motivos de consulta. La mayoría de los maltratos se producen dentro del entorno familiar(AU)

Aim: To measure the incidence of admissions for maltreatment between 1995 and 2009 and to determine their main clinical and epidemiological characteristics. Methods: Retrospective review of children diagnosed with maltreatment over 15years in a third level hospital. Results: A total of 97 cases (median incidence 0.5 cases per 1000 children admitted per year) were found. There was an increasing rate of physical maltreatment, while those of sexual abuse declined. 51 (53.6%) female; median age 3.3 years (p25-75: 7.6 months-10.0 years). Just under half (43.3%) or 42 patients, had a primary complaint unrelated to abuse. The most common injuries were haematomas (43; 44.3%). In 91 (93.8%) cases the perpetrator was found to be a member of the child's own family (77; 74.9%, one of the parents or both). Conclusions: The increase in admissions for physical maltreatment stresses the need to insist in a prevention policy. The decrease in admissions for sexual abuse was probably attributable to changes in the care circuit rather than a real decrease. In almost half of the cases the suspicion of maltreatment arose upon physical examination or after complementary tests, making it advisable that maltreatment is included in the differential diagnosis in multiple consultations. The majority of maltreatment occurred in the context of the victim's family(AU)

[Hospital admissions due to child maltreatment over a fifteen year period]. / Evolución de los ingresos por maltrato infantil durante 15 años.

AIM: To measure the incidence of admissions for maltreatment between 1995 and 2009 and to determine their main clinical and epidemiological characteristics. METHODS: Retrospective review of children diagnosed with maltreatment over 15 years in a third level hospital. RESULTS: A total of 97 cases (median incidence 0.5 cases per 1000 children admitted per year) were found. There was an increasing rate of physical maltreatment, while those of sexual abuse declined. 51 (53.6%) female; median age 3.3 years (p25-75: 7.6 months-10.0 years). Just under half (43.3%) or 42 patients, had a primary complaint unrelated to abuse. The most common injuries were haematomas (43; 44.3%). In 91 (93.8%) cases the perpetrator was found to be a member of the child's own family (77; 74.9%, one of the parents or both). CONCLUSIONS: The increase in admissions for physical maltreatment stresses the need to insist in a prevention policy. The decrease in admissions for sexual abuse was probably attributable to changes in the care circuit rather than a real decrease. In almost half of the cases the suspicion of maltreatment arose upon physical examination or after complementary tests, making it advisable that maltreatment is included in the differential diagnosis in multiple consultations. The majority of maltreatment occurred in the context of the victim's family.

Irradiación en portadores de válvula de derivación de líquido cefalorraquídeo. Seguimiento a los 2 años / Patients with cerebrospinal fluid shunt: radiation during two years of follow-up

Introducción: Las radiaciones ionizantes debido a pruebas diagnósticas y terapéuticas pueden contribuir al desarrollo posterior de neoplasias. Los pacientes portadores de válvulas de derivación líquido cefalorraquídeo (VDL) están expuestos a un mayor riesgo. Objetivo: Estimar la dosis de irradiación acumulada a las que son sometidos los pacientes portadores de VDL y los posibles factores asociados a una elevada irradiación. Métodos: Estudio descriptivo observacional. Se incluyen los niños a los que se les colocó una VDL en 2005 y 2006. Se contabilizan el número de exploraciones radiológicas realizadas para control neuroquirúrgico y por sospecha de disfunción valvular. Se determina la irradiación acumulada para cada paciente. Resultados: Se incluyen 36 pacientes con una mediana de edad de 6,1 meses (rango: 20 días-15,3 años). Se realizaron 136 tomografías craneales y 19 trayectos valvulares. La mediana de irradiación recibida por paciente fue de 6,9mSv (rango: 0-28,6mSv). El 85% de las exploraciones se realizaron para el control neuroquirúrgico. Los pacientes en los que se sospechó disfunción valvular presentaron una mediana de dosis absorbida más alta que aquellos en los que no se sospechó (9 vs. 5mSv; p=0,02). Conclusión: Es necesario ampliar el uso de técnicas no ionizantes para el control neuroquirúrgico de los pacientes portadores de VDL y desarrollar escalas clínico-diagnósticas que permitan seleccionar aquellos con mayor riesgo de disfunción valvular para reducir la potencial irradiación al que son sometidos(AU)

Background: Ionizing radiation due to diagnostic tests and treatment can contribute to the later development of cancer. The patients with cerebrospinal fluid shunts (CFS) are exposed to greater risk. Objective: To estimate the cumulative radiation dose from radiological studies in children with CFS and to determine the potential factors associated with a high level of radiation. Methods: Descriptive observational study. All children treated for hydrocephalus with a CFS between 2005 and 2006 were included. We registered the number of radiological examinations performed on these patients due to neurosurgical control or evaluation for possible shunt malfunction. The cumulative radiation dose from radiological studies was estimated for each patient. Results: Thirty-six patients were included. The median patient age was 6.1 months (range: 20 days - 15.3 years). One hundred thirty-six CT scans were performed and 19 shunt series were done. The median patient radiation was 6.9 mSv (range: 0 to 28.6 mSv); 85% of examinations were performed for neurosurgical control. The median absorbed radiation dose was higher in patients who were evaluated for some possible shunt malfunction than in patients without a suspected shunt malfunction (9 mSv vs 5 mSv, p=0.02). Conclusion: The radiation exposure from radiological examinations performed on children with CFS was considerable. The use of non-ionizing techniques would help in the neurosurgical control of patients with CSF. The development of clinical-diagnostic scales could enable patients with increased risk of shunt malfunction to be selected before a radiological test was carried out(AU)

[Patients with cerebrospinal fluid shunt: radiation during two years of follow-up]. / Irradiación en portadores de válvula de derivación de líquido cefalorraquídeo. Seguimiento a los 2 años.

BACKGROUND: Ionizing radiation due to diagnostic tests and treatment can contribute to the later development of cancer. The patients with cerebrospinal fluid shunts (CFS) are exposed to greater risk. OBJECTIVE: To estimate the cumulative radiation dose from radiological studies in children with CFS and to determine the potential factors associated with a high level of radiation. METHODS: Descriptive observational study. All children treated for hydrocephalus with a CFS between 2005 and 2006 were included. We registered the number of radiological examinations performed on these patients due to neurosurgical control or evaluation for possible shunt malfunction. The cumulative radiation dose from radiological studies was estimated for each patient. RESULTS: Thirty-six patients were included. The median patient age was 6.1 months (range: 20 days - 15.3 years). One hundred thirty-six CT scans were performed and 19 shunt series were done. The median patient radiation was 6.9 mSv (range: 0 to 28.6 mSv); 85% of examinations were performed for neurosurgical control. The median absorbed radiation dose was higher in patients who were evaluated for some possible shunt malfunction than in patients without a suspected shunt malfunction (9 mSv vs 5 mSv, p=0.02). CONCLUSION: The radiation exposure from radiological examinations performed on children with CFS was considerable. The use of non-ionizing techniques would help in the neurosurgical control of patients with CSF. The development of clinical-diagnostic scales could enable patients with increased risk of shunt malfunction to be selected before a radiological test was carried out.

Infección invasiva por «Staphylococcus aureus» resistente a meticilina de origen comunitario en pacientes pediátricos sanos / Invasive infection caused by community acquired methicillin resistant Staphylococcus aureus on healthy pediatric patients

Staphylococcus aureus resistente a meticilina de adquisición comunitaria (SARM-AC) es una bacteria implicada en infecciones de diversa gravedad y localización. En este trabajo exponemos la actualidad de las infecciones por SARM-AC en pediatría, y lo ilustramos con dos ejemplos de infección virulenta en pacientes pediátricos sanos. El primer caso corresponde a una paciente con artritis séptica y neumonía necrosante por SARM-AC, y el segundo a un lactante con pleuroneumonía por SARM-AC. Ambos casos son un claro ejemplo de la relevancia de esta infección emergente en pediatría (AU)

The community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is a bacterium that is frequently involved in severe infections and various locations. In this article we describe the actual state of CA-MRSA infections in pediatrics, and we illustrate it with two examples of virulent infection in healthy pediatric patients. The first case is in a patient with septic arthritis and necrotizing pneumonia caused by CA-MRSA, and the second one is in an unweaned baby with pleuropneumonia caused by CA-MRSA. Both cases are a clear example of the importance of this emerging infection in pediatrics (AU)

Guía de práctica clínica sobre la bronquiolitis aguda: descripción de la metodología utilizada / Acute bronchiolitis clinical practice guidelines: Description of the metodological process

Una guía de práctica clínica es un conjunto de recomendaciones desarrolladas de forma sistemática para ayudar a los profesionales y a los pacientes a tomar decisiones sobre la atención sanitaria más apropiada, y a seleccionar las opciones diagnósticas o terapéuticas más adecuadas para abordar un problema de salud o una condición clínica específica. La bronquiolitis aguda es la infección del tracto respiratorio inferior más frecuente en el lactante, pero existen controversias en cuanto al manejo de esta. Es por este motivo que se selecciona la bronquiolitis como entidad para la elaboración de una guía de práctica clínica. Describimos el proceso metodológico utilizado para la elaboración de la guía de práctica clínica sobre la bronquiolitis aguda (AU)

A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patient decisions about appropriate health care, and to select the most appropriate diagnostic or therapeutic options to address a health problem or a specific clinical condition. Acute bronchiolitis is the most common lower respiratory tract infection in infants. In spite of its hight prevalence, there is still controversy regarding its management. Therefore bronchiolitis is selected for the development of a CPG. We describe the methodological process used to develop the CPG on acute bronchiolitis (AU)

Guía de práctica clínica sobre la bronquiolitis aguda: recomendaciones para la práctica clínica / Acute bronchiolitis clinical practice guideline: recommendations for clinical practice

Existen controversias científicas en cuanto al manejo de la bronquiolitis aguda que generan una gran variabilidad en el abordaje de esta entidad. Una Guía de Práctica Clínica (GPC) es un conjunto de recomendaciones desarrolladas de forma sistemática para ayudar a los profesionales y a los pacientes a tomar decisiones basadas en la evidencia. Se ha seleccionado un grupo de grupo de trabajo (GT) formado por expertos que ha elaborado las preguntas clínicas a responder. Se ha realizado una búsqueda sistemática de la evidencia disponible sobre la bronquiolitis aguda y se ha evaluado. Posteriormente se ha resumido la información obtenida en tablas de evidencia y se han redactado unas recomendaciones a partir de éstas. El GT ha redactado un total de 46 preguntas clínicas agrupadas en apartados (diagnóstico, exploraciones complementarias, tratamiento, monitorización, prevención y evolución), que dan lugar a 133 recomendaciones. La GPC sobre la bronquiolitis aguda ofrece la oportunidad de unificar la práctica clínica habitual, basándose en la evidencia científica, lo que podría racionalizar el consumo de recursos sanitarios, mejorando la calidad asistencial y la equidad de acceso y utilización de los servicios (AU)

There are scientific controversies about the management of acute bronchiolitis that generate a great variability in the approach to this entity. A clinical practice guideline (CPG) is a set of systematically developed recommendations to assist practitioners and patients to make decisions based on evidence. A working group (WG) of experts has been selected and they have developed the clinical questions. A systematic search for evidence on the acute bronchiolitis has been done and the evidence has been assessed. The information obtained has been summarized in evidence tables and recommendations have been done from them. The WG has produced a total of 46 clinical questions grouped into sections (diagnosis, complementary tests, treatment, monitoring, prevention and evolution), resulting in 133 recommendations. The CPG on acute bronchiolitis provides an opportunity to unify clinical practice based on scientific evidence, which could rationalize the use of health resources, improving health care quality and equity of access to services (AU)

Hipocalcemia sintomática secundaria a raquitismo carencial. Presentación de dos casos clínicos / Symptomatic hypocalcaemia due to nutritional rickets. A presentation of two cases

Introducción: El raquitismo nutricional es una enfermedad considerada infrecuente en los países desarrollados, y el aumento en su incidencia se relaciona con el incremento de la inmigración en nuestro medio. Debido al incremento de esta patología en España, debemos aumentar nuestra sospecha diagnóstica y ser capaces de detectarla aún cuando se presente con síntomas poco usuales. Objetivo: Se presentan 2 casos clínicos de lactantes que debutaron con hipocalcemia sintomática y que fueron diagnosticados de raquitismo carencial. Caso 1. Lactante de 6 meses que presenta episodios de convulsiones tónicas e irritabilidad, sin otros hallazgos en la exploración física, constatándose una hipocalcemia secundaria a un raquitismo carencial. Caso 2. Lactante de 7 meses que realiza episodios de hipertonía generalizada, estridor inspiratorio e irritabilidad, con el resto de la exploración física normal, en el que también se constata hipocalcemia secundaria a raquitismo. Discusión: El concepto antiguo de que el raquitismo es una entidad rara en nuestro medio nos lleva muchas veces a descartar esta patología, retrasando el diagnóstico y el tratamiento. Debemos revisar nuestros conceptos y ser capaces de detectar síntomas frecuentes y también los poco usuales del raquitismo nutricional (AU)

Introduction: The nutritional rickets is considered an uncommon disease in developed countries, but the increase in its incidence appears to be related to the increase in the number of immigrants in these countries. Thus in Spain, we must increase our diagnostic suspicion of this disease and be able to detect it, even when it appears with unusual symptoms. We describe two clinical cases of breast-fed babies who presented with symptomatic hypocalcaemia and were diagnosed with rickets. Case 1. A six month-old breast-fed baby who had episodes of tonic seizures and irritability, with no other findings in the physical examination, and diagnosed with secondary hypocalcaemia due to nutritional rickets. Case 2. A seven month-old breast-fed baby who had generalised hypertonia, stridor and irritability, with a normal physical examination, and also diagnosed with hypocalcaemia secondary to rickets. Discussion: The old concept that rickets is a rare condition in our country means that we often tend to rule out this pathology, thus delaying the diagnosis and the treatment. We must review our concepts in order to be able to detect the common and also the unusual symptoms of nutritional rickets (AU)

[Symptomatic hypocalcaemia due to nutritional rickets. A presentation of two cases]. / Hipocalcemia sintomática secundaria a raquitismo carencial. Presentación de dos casos clínicos.

INTRODUCTION: The nutritional rickets is considered an uncommon disease in developed countries, but the increase in its incidence appears to be related to the increase in the number of immigrants in these countries. Thus in Spain, we must increase our diagnostic suspicion of this disease and be able to detect it, even when it appears with unusual symptoms. We describe two clinical cases of breast-fed babies who presented with symptomatic hypocalcaemia and were diagnosed with rickets. Case 1. A six month-old breast-fed baby who had episodes of tonic seizures and irritability, with no other findings in the physical examination, and diagnosed with secondary hypocalcaemia due to nutritional rickets. Case 2. A seven month-old breast-fed baby who had generalised hypertonia, stridor and irritability, with a normal physical examination, and also diagnosed with hypocalcaemia secondary to rickets. DISCUSSION: The old concept that rickets is a rare condition in our country means that we often tend to rule out this pathology, thus delaying the diagnosis and the treatment. We must review our concepts in order to be able to detect the common and also the unusual symptoms of nutritional rickets.

Diagnóstico de disfunción valvular en la edad pediátrica: valor predictivo de los síntomas y signos clínicos / Diagnosis of Valve dysfuntion in the paediatric age: the predictive value of the clinical sigsn and symptoms

Introducción. Las válvulas de derivación de líquido cefalorraquídeo son el tratamiento de elección en muchos delos casos de hidrocefalia infantil. La disfunción de las válvulas de derivación de líquido cefalorraquídeo habitualmente sepresenta de forma inespecífica, por lo que su diagnóstico se ve retrasado, lo que puede aumentar la morbimortalidad de estospacientes. Objetivo. Determinar los síntomas y signos más sugestivos de disfunción valvular en la población infantil. Pacientesy métodos. Estudio retrospectivo de los informes de los pacientes que consultaron al servicio de urgencias de un hospitalpediátrico de tercer nivel con clínica sugestiva de disfunción valvular. Se determinan en cada caso las manifestaciones clínicas,así como el diagnóstico o no de disfunción valvular. Se realiza un análisis univariante y posteriormente un estudio medianteregresión logística. Resultados. Se incluyeron 183 consultas. Se confirmó disfunción valvular en el 28,5%. La complicaciónmás frecuente fue la obstrucción del catéter de drenaje proximal. El análisis univariante demostró una relación significativaentre la presencia de irritabilidad, somnolencia, dolor abdominal, paresia de pares craneales y aumento del perímetrocraneal con la existencia de disfunción valvular. El modelo de regresión logística constató que somnolencia, irritabilidady dolor abdominal podían predecir disfunción valvular. Conclusiones. La somnolencia y la irritabilidad son las manifestacionesclínicas que mejor predicen una disfunción valvular, por lo que parece indiscutible que sean candidatas a estudio neurorradiológicourgente. El dolor abdominal se relaciona en la mayoría de casos con pseudoquistes abdominales. La cefalea, losvómitos y la fiebre son menos predictivos de disfunción valvular (AU)

Introduction. Cerebrospinal fluid shunt valves are the preferred treatment in many cases of childhood hydrocephalus.Cerebrospinal fluid shunt valve dysfunctions usually present in an unspecific manner, which delays their diagnosisand, consequently, can increase the morbidity and mortality rates in these patients. Aim. To determine the signs and symptomsthat are most suggestive of valve dysfunction in the childhood population. Patients and methods.We conducted a retrospectivestudy of the reports of patients who visited the emergency department of a tertiary care paediatric hospital with a clinicalpicture that suggested valve dysfunction. In each case the clinical manifestations were determined, and also whether there hadbeen a diagnosis of valve dysfunction or not. A univariate analysis and later a logistic regression study were performed.Results. In all, 183 visits were included. Valve dysfunction was confirmed in 28.5% of them. The most frequent complicationwas obstruction of the proximal drainage catheter. The univariate analysis showed a significant relation between the presenceof irritability, sleepiness, abdominal pain, paresis of the cranial nerves and increased perimeter of the skull, and the existenceof valve dysfunction. The logistic regression analysis revealed that sleepiness, irritability and abdominal pain could predictvalve dysfunction. Conclusions. Sleepiness and irritability are the clinical manifestations that best predict valve dysfunction,which means that they are almost undoubtedly candidates for an urgent neuroimaging study. In most cases the abdominal painis related to abdominal pseudocysts. Headaches, vomiting and a high temperature are less predictive of valve dysfunction (AU)

[Diagnosis of valve dysfunction in the paediatric age: the predictive value of the clinical signs and symptoms]. / Diagnóstico de disfunción valvular en la edad pediátrica: valor predictivo de los síntomas y signos clínicos.

INTRODUCTION: Cerebrospinal fluid shunt valves are the preferred treatment in many cases of childhood hydrocephalus. Cerebrospinal fluid shunt valve dysfunctions usually present in an unspecific manner, which delays their diagnosis and, consequently, can increase the morbidity and mortality rates in these patients. AIM: To determine the signs and symptoms that are most suggestive of valve dysfunction in the childhood population. PATIENTS AND METHODS: We conducted a retrospective study of the reports of patients who visited the emergency department of a tertiary care paediatric hospital with a clinical picture that suggested valve dysfunction. In each case the clinical manifestations were determined, and also whether there had been a diagnosis of valve dysfunction or not. A univariate analysis and later a logistic regression study were performed. RESULTS: In all, 183 visits were included. Valve dysfunction was confirmed in 28.5% of them. The most frequent complication was obstruction of the proximal drainage catheter. The univariate analysis showed a significant relation between the presence of irritability, sleepiness, abdominal pain, paresis of the cranial nerves and increased perimeter of the skull, and the existence of valve dysfunction. The logistic regression analysis revealed that sleepiness, irritability and abdominal pain could predict valve dysfunction. CONCLUSIONS: Sleepiness and irritability are the clinical manifestations that best predict valve dysfunction, which means that they are almost undoubtedly candidates for an urgent neuroimaging study. In most cases the abdominal pain is related to abdominal pseudocysts. Headaches, vomiting and a high temperature are less predictive of valve dysfunction.

Estudio multicéntrico sobre factores de riesgo de lesiones en accidentes de automóvil / Multicentre study on risk factors of injuries in car crashes

Introducción: Los accidentes de tráfico son la principal causa de muerte en niños de entre 2 y 14 años en países desarrollados. En este estudio se analiza la repercusión clínica, las características epidemiológicas, el uso y la adecuación de los sistemas de retención infantil (SRI) y su correlación con el tipo de lesiones en menores de 12 años de edad. Material y métodos: Estudio multicéntrico prospectivo descriptivo. Se recogieron los datos de filiación de las víctimas, los detalles técnicos de los accidentes, el uso y la adecuación del SRI, la clasificación de las lesiones según la localización y la gravedad, la necesidad de hospitalización, el tratamiento médico recibido, la activación del sistema de emergencias y el destino final del lesionado. Resultados: Se estudiaron 366 pacientes, la relación por sexos fue 1:1 y la mediana de edad fue de 6 años. El 69,7% presentó alguna lesión (el 92,3% eran lesiones leves). El 81,1% de las lesiones afectaron la cabeza y el cuello. El 77,9% utilizó algún tipo de SRI (adecuado sólo en el 55,7%). Se encontró mayor infrautilización del SRI en mayores de 6 años (27,1%; p<0,001). Circular en vía interurbana (odds ratio [OR]: 6,7) y no utilizar SRI adecuado (OR: 3,7) se relacionaron con la gravedad de las lesiones. La edad de los pacientes y la posición dentro del automóvil no estuvieron relacionadas. Todos los pacientes con escala de coma de Glasgow inferior a 8 y todos los pacientes fallecidos llevaban SRI inadecuados. Requirieron hospitalización el 8,7% y la tasa de mortalidad a las 24h fue del 0,8%. Conclusiones: Un porcentaje importante de los niños accidentados no utiliza SRI adecuados. La no utilización de un SRI o su utilización inadecuada es un factor de riesgo de morbilidad en los accidentes de tráfico en la infancia (AU)

Introduction: Traffic accidents are the main cause of death in children between 2 and 14 years in developed countries. We analysed their clinical repercussions, epidemiological characteristics, use and suitability of Child Restraint Systems (CRS) and its correlation with the type of injuries in children less than 12 years old. Material and methods: Multicentre descriptive prospective study. The following data was collected: personal details of the victims and the type of accident, use and suitability of the CRS, classification of injuries according to location and severity, need for hospitalisation, medical treatment received, use of Emergency Services and final destination of the injured. Results: A total of 366 patients were studied, with a sex ratio of 1:1 and a mean age of 6 years. Of these, 69.7% had some injury (slight 92.3%). A total of 81.1% affected the head and neck, and 77.9% used some type of CRS (suitable only in 55.7%). CRS were used more in >6 year olds (27.1%-P<0.001). Driving long distances (odds ratio 6.7) and not using a suitable CRS (odds ratio 3.7) were associated with the severity of the injuries. The age of the patients and the position within the automobile were not related. All the patients with a Glasgow less than 8 and all the deceased were using an unsuitable CRS. The hospitalization rate was 8.7% and the mortality rate at 24h was 0.8%. Conclusions: An important percentage of the injured children do not use suitable child restraint systems. Non-use of a CRS or its inadequate use is a risk factor of morbidity in the traffic accidents in childhood (AU)

[Multicentre study on risk factors of injuries in car crashes]. / Estudio multicéntrico sobre factores de riesgo de lesiones en accidentes de automóvil.

INTRODUCTION: Traffic accidents are the main cause of death in children between 2 and 14 years in developed countries. We analysed their clinical repercussions, epidemiological characteristics, use and suitability of Child Restraint Systems (CRS) and its correlation with the type of injuries in children less than 12 years old. MATERIAL AND METHODS: Multicentre descriptive prospective study. The following data was collected: personal details of the victims and the type of accident, use and suitability of the CRS, classification of injuries according to location and severity, need for hospitalisation, medical treatment received, use of Emergency Services and final destination of the injured. RESULTS: A total of 366 patients were studied, with a sex ratio of 1:1 and a mean age of 6 years. Of these, 69.7% had some injury (slight 92.3%). A total of 81.1% affected the head and neck, and 77.9% used some type of CRS (suitable only in 55.7%). CRS were used more in >6 year olds (27.1%-P<0.001). Driving long distances (odds ratio 6.7) and not using a suitable CRS (odds ratio 3.7) were associated with the severity of the injuries. The age of the patients and the position within the automobile were not related. All the patients with a Glasgow less than 8 and all the deceased were using an unsuitable CRS. The hospitalization rate was 8.7% and the mortality rate at 24h was 0.8%. CONCLUSIONS: An important percentage of the injured children do not use suitable child restraint systems. Non-use of a CRS or its inadequate use is a risk factor of morbidity in the traffic accidents in childhood.

[Parental presence during invasive procedures in the emergency department]. / ¿Deberían estar presentes los padres durante los procedimientos invasivos en urgencias?

Over the last decades, health care has been moving away from the paternalistic model, to one of family-centered care. In the pediatric emergency department, this new trend has led to parents playing a larger role in the health care of children, particularly during invasive procedures and/or resuscitation. Despite the increased attention to family presence, it remains a controversial topic, especially among emergency medical staff. Several studies have been performed that look at the advantages and disadvantages of this new way of conceiving child health care. To our knowledge, there is only one Spanish article on this topic, which is the reason why we performed a literature review on family presence in the emergency department.

¿Deberían estar presentes los padres durante los procedimientos invasivos en urgencias? / Parental presence during invasive procedures in the emergency department

En las últimas décadas, el modelo de medicina paternalista se ha sustituido por un modelo centrado en el sujeto y sus familiares. En el ámbito de las urgencias pediátricas, este hecho ha conllevado un mayor protagonismo de los padres, especialmente durante la realización de procedimientos invasivos. Numerosos autores han estudiado las ventajas y los inconvenientes de esta nueva práctica, tanto para los sujetos y sus familiares como para el personal sanitario. Dada la escasa bibliografía española, se revisó la literatura médica publicada hasta el momento y se analizaron los posibles beneficios y perjuicios para el sujeto y sus familiares, así como la posición de los profesionales sanitarios(AU)

Over the last decades, health care has been moving away from the paternalistic model, to one of family-centered care. In the pediatric emergency department, this new trend has led to parents playing a larger role in the health care of children, particularly during invasive procedures and/or resuscitation. Despite the increased attention to family presence, it remains a controversial topic, especially among emergency medical staff. Several studies have been performed that look at the advantages and disadvantages of this new way of conceiving child health care. To our knowledge, there is only one Spanish article on this topic, which is the reason why we performed a literature review on family presence in the emergency department(AU)

[Violence and adolescence. A perspective from and Emergency Department]. / Violencia y adolescencia. Perspectiva desde un servicio de urgencias.

INTRODUCTION AND AIM: The acts of violence between adolescents are becoming increasingly more common, generating problems of a diverse nature. The knowledge of the circumstances that surround this violence is important to implement measures to decrease their incidence. The aim of this study was to describe the epidemiology of violent assault in teenagers from the perspective of an Emergency Department. MATERIAL AND METHOD: Retrospective analysis of information recorded on adolescent victims of assault, who attended our Emergency Department over a 1 year period (2006), was performed. RESULTS: Of the 105 patients included, the mean age of the assault victims was 15.9 (SD: 1.4) years. Of those, 73.3 % were male. They were seen at holidays (58.1 %) and predominantly between the hours of 8 pm and 4 am (55.2 %). Forty-nine (46.7 %) of the events were classified as fights, 44 (41.9 %) as assaults, 7 (6.7 %) as physical abuse and 5 (4.8 %) as sexual abuse. Overall, 20 (19 %) patients reported that there was a weapon at the scene: in 13.3 % a blunt object and in 5.7 % a knife/piercing object. Bruises or haematomas were present in 93.3 % of patients; lacerations in 19 % and fractures in 11.4 %. Sixty-two (59 %) patients needed an X-ray, 10 (9.5 %) a urineanalysis and 7 (6.7 %) a blood test. Seven (6.7 %) patients were hospitalised and 6 (5.7 %) were evaluated by Social Work. CONCLUSIONS: The knowledge of the epidemiology of this problem and awareness by the professionals involved in handling this, must promote the coordinated creation of protocols and actions that can decrease its impact among adolescents, and in turn, society.

Violencia y adolescencia. Perspectiva desde un servicio de urgencias / Violence and adolescence. A perspective from and Emergency Department

Introducción y objetivo: Los actos de violencia entre adolescentes son cada vez más frecuentes y generan problemas de índole diversa. El conocimiento de las circunstancias que los rodean es importante para instaurar medidas que disminuyan su incidencia. El objetivo de este trabajo es analizar las características de las víctimas de agresiones atendidas en nuestro servicio de urgencias. Material y método: Estudio retrospectivo de los informes de urgencias de los adolescentes que fueron visitados en el año 2006 por haber sido agredidos y en los que se emitió un parte de lesiones. Resultados: Fueron 105 pacientes, con una edad media de 15,9 años (DE: 1,4 años) y predominio masculino (77 casos, 73,3 %). El 55,2 % de las visitas se produjeron entre las 20.00 y las 4.00 h; el 58,1 % en día festivo. El motivo de la consulta estaba relacionado con una pelea en 49 casos (46,7 %), con una agresión sin pelea en 44 (41,9 %), con maltrato físico en 7 (6,7 %) y con abuso sexual en 5 (4,8 %). En el 85,1 % se había usado la fuerza física; en el 13,3 %, instrumentos no cortantes, y en el 5,7 %, armas blancas. Las contusiones fueron las lesiones más frecuentes, en 98 pacientes (93,3 %), seguidas de heridas abiertas y fracturas, en 20 (19 %) y 12 casos (11,4 %), respectivamente. Requirieron pruebas de radiodiagnóstico 62 adolescentes (59 %), análisis de orina 10 (9,5 %) y hemograma 7 (6,7 %). Ingresaron 7 pacientes (6,7 %) y 6 (5,7 %) fueron valorados por Trabajo Social. Conclusiones: El conocimiento de la epidemiología de este problema y su difusión entre los profesionales implicados en su manejo debe promover la creación de protocolos y acciones coordinadas que puedan minimizar su impacto entre los adolescentes y, por lo tanto, en la sociedad

Introduction and aim: The acts of violence between adolescents are becoming increasingly more common, generating problems of a diverse nature. The knowledge of the circumstances that surround this violence is important to implement measures to decrease their incidence. The aim of this study was to describe the epidemiology of violent assault in teenagers from the perspective of an Emergency Department. Material and method: Retrospective analysis of information recorded on adolescent victims of assault, who attended our Emergency Department over a 1 year period (2006), was performed. Results: Of the 105 patients included, the mean age of the assault victims was 15.9 (SD: 1.4) years. Of those, 73.3 % were male. They were seen at holidays (58.1 %) and predominantly between the hours of 8 pm and 4 am (55.2 %). Forty-nine (46.7 %) of the events were classified as fights, 44 (41.9 %) as assaults, 7 (6.7 %) as physical abuse and 5 (4.8 %) as sexual abuse. Overall, 20 (19 %) patients reported that there was a weapon at the scene: in 13.3 % a blunt object and in 5.7 % a knife/piercing object. Bruises or haematomas were present in 93.3 % of patients; lacerations in 19 % and fractures in 11.4 %. Sixty-two (59 %) patients needed an X-ray, 10 (9.5 %) a urineanalysis and 7 (6.7 %) a blood test. Seven (6.7 %) patients were hospitalised and 6 (5.7 %) were evaluated by Social Work. Conclusions: The knowledge of the epidemiology of this problem and awareness by the professionals involved in handling this, must promote the coordinated creation of protocols and actions that can decrease its impact among adolescents, and in turn, society