Multicenter study. Nursing professionals' perception of training needs in pain assessment in pediatric patients with cognitive dysfunction.

INTRODUCTION: Pediatric patients with cognitive dysfunction are at greater risk of pain than typically developing children. Pain assessment in these patients is complex and could generate uncertainty in health professionals about what the key aspects are. AIM: To determine the training needs perceived by nursing professionals regarding acute pain assessment in pediatric patients with cognitive dysfunction. METHODS: A descriptive, cross-sectional, and multicenter study was performed using a survey addressed to nursing professionals who work in pediatrics during the months of August and September 2022. RESULTS: 163 responses were obtained. Most of the professionals who responded were female (92.6%, n = 151), with a mean age of 38.98 ±â€¯10.40 years. The most frequent work unit was the pediatric intensive care unit (PICU), in 36% (n = 58). Most of the participants reported not having previously received training on pain assessment in pediatric patients with cognitive disabilities (85.9%, n = 139). However, 70.4% (n = 114) considered it "very necessary" for the development of their work to receive specific training on this topic. Knowing how to assess acute pain in this population (85.3%, n = 139) and knowing the clinical and behavioral manifestations of pain in this type of patient (84.7%, n = 138) were the aspects that obtained higher scores. CONCLUSION: This research notes more than 90% of participants consider "quite necessary" and "strong necessary" to be training in pediatric cognitive dysfunction patients pain assessment. Furthermore, work experience, academic education and to be pediatric specialist obtain statistical significance data.

Complicaciones del traslado intrahospitalario del paciente pediátrico en oxigenación por membrana extracorpórea / Complications during intra-hospital transport of pediatric patient on extracorporeal membrane oxygenation

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ECMO venovenosa / No disponible

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Escalas de gravedad clínica en UCIP / Clinical severity scale in PICU

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Rabdomiolisis secundaria a hipernatremia / Rhabdomyolysis secondary tohypernatraemia

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Utilización de la craniectomía descompresiva en el manejo de la hipertensión intracraneal refractaria en la edad pediátrica / Use of decompressive craniectomy in the management of refractory intracranial hypertension in paediatric patients

Introducción y objetivo: La hipertensión intracraneal (HITC) es la principal causa de mortalidad y secuelas de los pacientes con traumatismo craneoencefálico grave. La craniectomía descompresiva (CD) es una técnica quirúrgica que permite disminuir la presión intracraneal y mejorar la presión de perfusión cerebral (PPC). El objetivo del trabajo es presentar la experiencia con la CD para el tratamiento de la hipertensión intracraneal. Pacientes y métodos: Revisión retrospectiva de los pacientes ingresados entre los años 2005–2008 con lesión cerebral e hipertensión intracraneal incontrolable médicamente a los que se les realizó una CD como terapia. Resultados: Se incluyen 14 pacientes con traumatismo craneoencefálico grave con una mediana de edad de 14,2 años (4–20 años). Las lesiones detectadas más frecuentemente en la TC craneal de los niños con traumatismo fueron las lesiones encefálicas difusas II y III. En todos se practicó una CD por presentar cifras de presión intracraneal elevadas refractarias a la terapéutica instaurada. La evolución fue favorable en todos los pacientes salvo en 2. El 78,8% presenta una buena evolución neurológica (Glasgow Outcome Score 4 y 5) a los 6 meses de la intervención. Conclusión: La CD es una alternativa en el manejo de la hipertensión intracraneal refractaria al tratamiento médico en niños y adolescentes que han sufrido un traumatismo craneoencefálico grave y puede ser usada simultáneamente o como alternativa al coma barbitúrico sobre todo en aquellos pacientes con inestabilidad hemodinámica (AU)

Introduction and objective: Intracranial hypertension (ICH) is the main cause of morbidity and mortality in patients with severe traumatic head injuries. Decompressive craniectomy (DC) is a surgical technique that allows to reduce intracranial pressure (ICP) and to improve cerebral blood flow. Objective: To present our experience on DC for the treatment of ICH. Patients and methods: Retrospective review of patients admitted from January 2005 to December 2008 who had a traumatic brain injury (TBI) and uncontrollable intracranial hypertension despite optimal medical treatment and who needed DC. Results: Fourteen patients with severe TBI were included in this series. Mean age was 14.2 years (4–20 years). The more frequent damages detected in cranial computerized tomography were diffuse brain lesions types II and III. Indication for DC was made if ICP levels were above 25mmHg for more than 30min despite optimal medical treatment. Clinical outcome was favourable in all patients apart from two. Neurological outcome was correct in 78.8% of patients (Glasgow Outcome Score 4 and 5) six months after PICU discharge. Conclusion: DC is an alternative for the management of refractory intracranial hypertension in children and adolescents with severe TBI. It could be used simultaneously with the barbiturate coma or as an alternative, particularly in haemodynamically unstable patients (AU)

[Use of decompressive craniectomy in the management of refractory intracranial hypertension in paediatric patients]. / Utilización de la craniectomía descompresiva en el manejo de la hipertensión intracraneal refractaria en la edad pediátrica.

INTRODUCTION AND OBJECTIVE: Intracranial hypertension (ICH) is the main cause of morbidity and mortality in patients with severe traumatic head injuries. Decompressive craniectomy (DC) is a surgical technique that allows to reduce intracranial pressure (ICP) and to improve cerebral blood flow. OBJECTIVE: To present our experience on DC for the treatment of ICH. PATIENTS AND METHODS: Retrospective review of patients admitted from January 2005 to December 2008 who had a traumatic brain injury (TBI) and uncontrollable intracranial hypertension despite optimal medical treatment and who needed DC. RESULTS: Fourteen patients with severe TBI were included in this series. Mean age was 14.2 years (4-20 years). The more frequent damages detected in cranial computerized tomography were diffuse brain lesions types II and III. Indication for DC was made if ICP levels were above 25 mmHg for more than 30 min despite optimal medical treatment. Clinical outcome was favourable in all patients apart from two. Neurological outcome was correct in 78.8% of patients (Glasgow Outcome Score 4 and 5) six months after PICU discharge. CONCLUSION: DC is an alternative for the management of refractory intracranial hypertension in children and adolescents with severe TBI. It could be used simultaneously with the barbiturate coma or as an alternative, particularly in haemodynamically unstable patients.

Enfermedad respiratoria y parálisis diafragmática en la enfermedad de Charcot-Marie-Tooth / Respiratory disease and diaphragm paralysis in Charcot-Marie-Tooth disease

La disfunción diafragmática bilateral es una entidad infrecuente. Dentro del ámbito pediátrico las causas más comunes son las asociadas a traumatismo obstétrico o cirugía cardiovascular. En el diagnóstico diferencial se incluye la enfermedad de Charcot-Marie-Tooth (CMT).Si bien en esta enfermedad es infrecuente, la afectación de la musculatura respiratoria, por su carácter distal, está descrita su asociación con neumopatía restrictiva secundaria a una disfunción del nervio frénico con paresia diafragmática bilateral o anomalías de la pared torácica. Presentamos 2 casos de CMT que ingresaron en la Unidad de Cuidados Intensivos con fallo respiratorio tipo II. En ambos casos el tratamiento con ventilación no invasiva produjo una mejoría clínica significativa. A destacar el hecho de que en uno de los pacientes la evidencia de una afectación frénica sirvió como signo guía para el diagnóstico de su enfermedad de base (AU)

Diaphragmatic bilateral palsy is uncommon in children. The most important etiologies are thoracic surgery and obstetric trauma. Respiratory muscle impairment is a rare phenomenon in patients with Charcot-Marie-Tooth disease (CMT). However, it can be associated with restrictive pulmonary impairment, phrenic nerve dysfunction or thoracic cage abnormalities. We report two paediatric cases of CMT disease with type 2 respiratory failure due to diaphragmatic dysfunction. In both cases treatment with non-invasive mechanical ventilation resulted in satisfactory clinical improvement. Evidence of phrenic damage was the main clue in one patient in order to obtain an accurate diagnostic of her disease (AU)

[Respiratory disease and diaphragm paralysis in Charcot-Marie-Tooth disease]. / Enfermedad respiratoria y parálisis diafragmática en la enfermedad de Charcot-Marie-Tooth.

Diaphragmatic bilateral palsy is uncommon in children. The most important etiologies are thoracic surgery and obstetric trauma. Respiratory muscle impairment is a rare phenomenon in patients with Charcot-Marie-Tooth disease (CMT). However, it can be associated with restrictive pulmonary impairment, phrenic nerve dysfunction or thoracic cage abnormalities. We report two paediatric cases of CMT disease with type 2 respiratory failure due to diaphragmatic dysfunction. In both cases treatment with non-invasive mechanical ventilation resulted in satisfactory clinical improvement. Evidence of phrenic damage was the main clue in one patient in order to obtain an accurate diagnostic of her disease.

Aplicación de ventilación no invasiva en pacientes postoperados cardíacos. Estudio retrospectivo / Non-invasive ventilation after cardiac surgery. A prospective study

Objetivos: Describir según la experiencia de los autores el uso de la ventilación no invasiva (VNI) en pacientes postoperados cardíacos. Material y métodos: Estudio prospectivo de los pacientes postoperados cardíacos ingresados en la unidad de cuidados intensivos pediátricos (UCIP) entre los años 2004 y 2007 que precisaron VNI tras extubación. Resultados: Durante este período se intervinieron de cirugía cardíaca 331 pacientes, de los cuales 159 pacientes llegaron extubados a la unidad. Se aplicó VNI en 29 episodios sobre 26 pacientes. Las cardiopatías más frecuentes fueron Fallot y canal auriculoventricular. Diecinueve (65%) pacientes presentaron fallo respiratorio (FR) de tipo II y el resto presentó FR de tipo I. Los problemas respiratorios más frecuentes fueron el edema agudo de pulmón (EAP) y la atelectasia. En un 70% de los episodios la indicación fue electiva. El tipo de respirador más utilizado fue el BiPAP Vision y, en cuanto a la modalidad, la más utilizada fue el Spontaneous/Timed que supuso el 56%. La duración media de la VNI fue de 64h (rango de 41 a 88h). Los pacientes tuvieron una estancia media en la UCIP de 22 días. Nueve pacientes requirieron reintubación, ninguno de ellos de forma precoz (primeras 12h), lo que supone una eficacia del 66%. La eficacia de la VNI se correlacionó con el tipo de enfermedad y de forma inversa con las horas de uso de ésta. Se presentaron complicaciones en 12 episodios. Cuatro pacientes requirieron traqueostomía, todos ellos presentaban neumopatía asociada a hiperaflujo pulmonar previo. No falleció ningún paciente. Conclusiones: La VNI es eficaz y segura durante el postoperatorio cardíaco. Su eficacia es muy alta en caso de atelectasia o de EAP. El fracaso de la VNI se asocia de forma destacada a la afectación pulmonar previa a la cirugía, secundaria a la cardiopatía. Debe plantearse con cautela la indicación de la VNI en este subgrupo de pacientes (AU)

Aim: To report our experience with non-invasive ventilation (NIV) after cardiac surgery. Materials and methods: Prospective study of cardiac surgery patients admitted to our PICU between 2004 and 2007 who required NIV after extubation. Results: A total of 331 patients were admitted to the unit after cardiac surgery during this period. Of these, 159 were extubated in the operatin groom. NIV was introduced in 29 episodes on 26 patients. Fallot’s tetralogy and AVD were the most common heart diseases, and 65% had type II respiratory failure. The respiratory problems usually involved were acute pulmonary oedema and atelectasis. Indication was elective in 70% of episodes. BiPAP Vision was the common est ventilator used and in the S/T mode(56%). Average length of use was 64h. Average length of stay in PICU was 22 days. Nine patients required reintubation, none of them at an early stage (first12h) which represents an efficiency of 66%. The effectiveness of NIV was related to the type of disease and inversely with the time NIV was needed. There were complications in 12 episodes. Four patients required tracheostomy, all of which were associated with previous lung disease. Survival was 100%. Conclusions: NIV is effective and safe after cardiac surgery. It has very good results in respiratory failure due to atelectasis or pulmonary oedema. NIV failure in these patients is strongly associated with preoperative pulmonary sequelae secondary to heart disease. NIV indication in these patients has to be carefully evaluated (AU)

[Pediatric intensive care after brain tumor surgery]. / Postoperatorio de tumores cerebrales en la unidad de cuidados intensivos pediátricos.

INTRODUCTION: Primary brain tumors are the most common solid tumors in children. Surgery is the basis of treatment for these patients, who require postoperative admission to the ICU-P. The aim of this study was to at the epidemiology of brain tumors of patients admitted to our ICU-P and to analyze the progress of these children in the postoperative period. PATIENTS AND METHODS: Retrospective-prospective study of children admitted to our unit after brain tumor surgery between January 1998 and January 2007. We collected information such as, personal details, clinical characteristics, type of intervention and postoperative period. RESULTS: We reviewed 161 postoperative periods, corresponding to 134 patients (54.5% male). The mean age was 7 years and 8 months +/- 5 months. The most common location was the posterior fossa (44.8%). The most common histological type was low grade/intermediate astrocytoma (44.7%). The most frequent complication was diabetes insipidus (9.9%). Resection was complete in 58.4% patients. The median stay in the ICU-P was 2 days (0-61 days). 3 patients died after surgery. CONCLUSIONS: The epidemiology of the group of patients admitted to our ICU-P is similar to the general population. The most common complication is diabetes insipidus.

[Non-invasive ventilation after cardiac surgery. A prospective study]. / Aplicación de ventilación no invasiva en pacientes postoperados cardíacos. Estudio retrospectivo.

AIM: To report our experience with non-invasive ventilation (NIV) after cardiac surgery. MATERIALS AND METHODS: Prospective study of cardiac surgery patients admitted to our PICU between 2004 and 2007 who required NIV after extubation. RESULTS: A total of 331 patients were admitted to the unit after cardiac surgery during this period. Of these, 159 were extubated in the operating room. NIV was introduced in 29 episodes on 26 patients. Fallot's tetralogy and AVD were the most common heart diseases, and 65% had type II respiratory failure. The respiratory problems usually involved were acute pulmonary oedema and atelectasis. Indication was elective in 70% of episodes. BiPAP Vision was the commonest ventilator used and in the S/T mode (56%).Average length of use was 64h. Average length of stay in PICU was 22 days. Nine patients required reintubation, none of them at an early stage (first 12h) which represents an efficiency of 66%. The effectiveness of NIV was related to the type of disease and inversely with the time NIV was needed. There were complications in 12 episodes. Four patients required tracheostomy, all of which were associated with previous lung disease. Survival was 100%. CONCLUSIONS: NIV is effective and safe after cardiac surgery. It has very good results in respiratory failure due to atelectasis or pulmonary oedema. NIV failure in these patients is strongly associated with preoperative pulmonary sequelae secondary to heart disease. NIV indication in these patients has to be carefully evaluated.

Postoperatorio de tumores cerebrales en la unidad de cuidados intensivos pediátricos / Pediatric intensive care after brain tumor surgery

Introducción: Los tumores primarios cerebrales son la neoplasia sólida más frecuente en la infancia. La base fundamental del tratamiento de estos pacientes es la cirugía, cuyo postoperatorio requiere ingreso en la unidad de cuidados intensivos pediátricos (UCIP). Los objetivos de nuestro trabajo son: conocer la epidemiología de los tumores que ingresan en nuestra unidad y analizar el postoperatorio de estos niños. Pacientes y métodos: Estudio prospectivo y retrospectivo de todos los niños intervenidos de tumor cerebral desde enero de 1998 hasta enero de 2007 en nuestro hospital. Se recogen datos referentes a filiación, características clínicas, tipo de intervención y postoperatorio. Resultados: Se revisan 161 postoperatorios, correspondientes a 134 pacientes (el 54,5%, varones). La media ± desviación estándar de edad es 7 años y 8 meses ± 5 meses. La localización más frecuente es la fosa posterior (44,8%). El tipo histológico principal es el astrocitoma de grado bajo/intermedio (44,7%). La complicación más frecuente es la diabetes insípida (9,9%). La resección es total en el 58,4% de los pacientes. La mediana de estancia en UCIP es de 2 días (0-61 días). Fallecieron 3 pacientes tras la intervención. Conclusiones: La epidemiología del grupo de pacientes que llega a UCIP es similar a la población general. La complicación más frecuente es la diabetes insípida (AU)

Introduction: Primary brain tumors are the most common solid tumors in children. Surgery is the basis of treatment for these patients, who require postoperative admission to the ICU-P. The aim of this study was to at the epidemiology of brain tumors of patients admitted to our ICU-P and to analyze the progress of these children in the postoperative period. Patients and methods: Retrospective-prospective study of children admitted to our unit after brain tumor surgery between January 1998 and January 2007. We collected information such as, personal details, clinical characteristics, type of intervention and postoperative period. Results: We reviewed 161 postoperative periods, corresponding to 134 patients (54.5% male). The mean age was 7 years and 8 months±5 months. The most common location was the posterior fossa (44.8%). The most common histological type was low grade/intermediate astrocytoma (44.7%). The most frequent complication was diabetes insipidus (9.9%). Resection was complete in 58.4% patients. The median stay in the ICU-P was 2 days (0–61 days). 3 patients died after surgery .Conclusions: The epidemiology of the group of patients admitted to our ICU-P is similar to the general population. The most common complication is diabetes insipidus (AU)

[Fluid and electrolyte disorders following surgery for brain tumors]. / Trastornos hidroelectrolíticos en postoperados de tumores cerebrales.

INTRODUCTION: Fluid and electrolyte disorders such as diabetes insipidus, salt wasting syndrome (SWS) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) can appear in the immediate postoperative period after surgery for brain tumors. Early diagnosis and treatment are important to prevent the potential adverse effects of these disorders on the central nervous system (CNS). OBJECTIVES: To determine the incidence and characteristics of fluid and electrolyte disorders in the immediate postoperative period after surgery for CNS tumors in children treated in our hospital. MATERIAL AND METHODS: We retrospectively analyzed clinical and laboratory data in all infants and children who underwent surgery for CNS tumors in our hospital from January 1998 to June 2005 and who met the laboratory criteria for diabetes insipidus, SWS or SIADH. RESULTS: Twenty-three electrolyte disorders were identified in 149 surgical patients (an incidence of 15.4%). The median age was 5 years and 3 months (from 6 months to 17 years) and 48.7% of the patients were male. The most frequent electrolyte disturbance was diabetes insipidus (65.2% of all electrolyte disorders). On average, onset of diabetes insipidus occurred 19 hours after surgery. Treatment with desmopressin was administrated in all patients. On average, diabetes insipidus was resolved 73 hours after diagnosis, except in one patient with permanent diabetes insipidus due to a surgical lesion of the hypothalamic-pituitary axis. The second most frequent electrolyte disturbance was SWS (26.1%) with a mean time of onset of 50.4 hours after surgery. On average, SWS was resolved 57.6 hours after administration of saline solutions. Only two patients developed SIADH, which was treated with water restriction and adequate sodium supply. Both cases of SIADH resolved spontaneously in the first 36 hours after diagnosis. At discharge, none of the patients showed neurological disturbances due to an electrolytic disorder. CONCLUSIONS: In our series, the most frequent electrolyte disorder after surgery for CNS tumors was diabetes insipidus. Early treatment with desmopressin almost always prevents hypernatremia. Unless there is a surgical lesion of the hypothalamic-pituitary axis, spontaneous resolution will take place in 3 days on average. The management of SWS and SIADH requires close monitoring of plasma sodium due to the risk of hyponatremia.

Trastornos hidroelectrolíticos en postoperados de tumores cerebrales / Fluid and electrolyte disorders following surgery for brain tumors

Introducción Entre las complicaciones que pueden aparecer en el postoperatorio inmediato de los tumores cerebrales destacan los trastornos hidroelectrolíticos (diabetes insípida, síndrome pierde sal y síndrome de secreción inadecuada de hormona antidiurética [SIADH]). Es importante su diagnóstico y tratamiento precoz de cara a prevenir los posibles efectos negativos que pueden tener sobre el propio sistema nervioso central (SNC). Objetivos Valorar la incidencia y características de los trastornos electrolíticos aparecidos en el postoperatorio inmediato de los niños intervenidos de tumores del SNC en nuestro centro. Material y métodos Análisis retrospectivo de las historias clínicas de niños intervenidos de tumores del SNC en nuestro centro entre enero de 1998 y junio de 2005, que en el postoperatorio cumplieron criterios analíticos de diabetes insípida, síndrome pierde sal o SIADH. Resultados Se detectaron 23 trastornos hidroelectrolíticos en 149 intervenciones (15,4 %). El 47,8 % fueron varones. La mediana de edad fue de 5 años y 3 meses (rango de 6 meses a 17 años). La alteración electrolítica más frecuente fue diabetes insípida (65,2 %). El trastorno apareció en una media de 19 h tras la cirugía. Se administró desmopresina en todos los casos, con resolución del cuadro en una media de 73 h tras el diagnóstico, excepto un caso de diabetes insípida permanente por lesión quirúrgica del eje hipotálamo- hipofisario. El síndrome pierde sal, con un 26,1 % de los casos, fue el segundo trastorno hidroelectrolítico en frecuencia. El tiempo medio de aparición tras la cirugía fue de 50,4 h. Se adecuó el aporte hidrosalino en todos los casos. El trastorno se resolvió en una media de 57,6 h tras su aparición. Sólo se detectaron 2 casos de SIADH que se trataron con restricción hídrica y adecuación de aportes de sodio. Ambos casos se resolvieron espontáneamente en las primeras 36 h tras el diagnóstico. Al alta ningún paciente presentaba alteraciones neurológicas secundarias al trastorno hidroelectrolítico. Conclusiones El trastorno hidroelectrolítico más frecuente en postoperados de tumores cerebrales en nuestra serie ha sido la diabetes insípida. El tratamiento precoz con desmopresina evita en la mayor parte de los casos la aparición de hipernatremia. Si no existe lesión quirúrgica del eje hipotálamo- hipofisario la resolución espontánea se produce en una media de 3 días. El manejo del síndrome pierde sal y el SIADH requiere una estrecha monitorización del sodio plasmático por la gran tendencia a la hiponatremia

Introduction Fluid and electrolyte disorders such as diabetes insipidus, salt wasting syndrome (SWS) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) can appear in the immediate postoperative period after surgery for brain tumors. Early diagnosis and treatment are important to prevent the potential adverse effects of these disorders on the central nervous system (CNS). Objectives To determine the incidence and characteristics of fluid and electrolyte disorders in the immediate postoperative period after surgery for CNS tumors in children treated in our hospital. Material and methods We retrospectively analyzed clinical and laboratory data in all infants and children who underwent surgery for CNS tumors in our hospital from January 1998 to June 2005 and who met the laboratory criteria for diabetes insipidus, SWS or SIADH. Results Twenty-three electrolyte disorders were identified in 149 surgical patients (an incidence of 15.4 %). The median age was 5 years and 3 months (from 6 months to 17 years) and 48.7 % of the patients were male. The most frequent electrolyte disturbance was diabetes insipidus (65.2 % of all electrolyte disorders). On average, onset of diabetes insipidus occurred 19 hours after surgery. Treatment with desmopressin was administrated in all patients. On average, diabetes insipidus was resolved 73 hours after diagnosis, except in one patient with permanent diabetes insipidus due to a surgical lesion of the hypothalamic-pituitary axis. The second most frequent electrolyte disturbance was SWS (26.1 %) with a mean time of onset of 50.4 hours after surgery. On average, SWS was resolved 57.6 hours after administration of saline solutions. Only two patients developed SIADH, which was treated with water restriction and adequate sodium supply. Both cases of SIADH resolved spontaneously in the first 36 hours after diagnosis. At discharge, none of the patients showed neurological disturbances due to an electrolytic disorder. Conclusions In our series, the most frequent electrolyte disorder after surgery for CNS tumors was diabetes insipidus. Early treatment with desmopressin almost always prevents hypernatremia. Unless there is a surgical lesion of the hypothalamic- pituitary axis, spontaneous resolution will take place in 3 days on average. The management of SWS and SIADH requires close monitoring of plasma sodium due to the risk of hyponatremia

Influencia de la prueba de detección rápida del virus de la gripe en el manejo del niño febril en urgencias pediátricas / Influence of the rapid influenza virus detection test on the management of the febrile child in the paediatric emergency setting

Objetivos: Determinar las características clínicas de los pacientes diagnosticados de gripe con una prueba de detección rápida y constatar las diferencias de actuación en Urgencias con respecto a los pacientes con resultado negativo. Métodos: Revisión de las historias clínicas de aquellos pacientes a los que se solicitó una prueba de detección rápida para virus Influenza en aspirado nasofaríngeo. Resultados: Se solicitó el test en 142 pacientes (mediana de edad: 2,4 meses). Se obtuvo un resultado positivo en 63 (44,4%). La indicación principal fue fiebre asociada a clínica respiratoria (62,7%), seguida de fiebre sin foco (33,8%). De todos los pacientes con gripe sólo uno presentó un urocultivo positivo; los hemocultivos realizados y los cultivos de LCR fueron negativos. Al comparar los pacientes diagnosticados de gripe con aquéllos sin gripe no se detectaron diferencias en cuanto al sexo, edad, presencia de fiebre alta o de síntomas respiratorios. Por el contrario, los pacientes con gripe tenían menos dificultad respiratoria (1,6% vs 17,7%) y existía con más frecuencia ambiente epidémico en el domicilio (54% vs 31,6%) (p<0,01). A los pacientes con test de diagnóstico rápido positivo se les practicaron menos radiografías de tórax (30,2% vs 51,9%) (p<0,01), ingresaron menos (19% vs 57%) (p<0,001) y recibieron menos antibiótico (14,3% vs 40,5%) (p<0,001). En el subgrupo de 25 pacientes menores de 1 mes no se encontraron diferencias en ninguno de los parámetros estudiados. Conclusiones: Los pacientes con test positivo para Influenza presentan escasas características clínicas diferenciales. Disponer de técnicas de diagnóstico rápido para la gripe en Urgencias cambia el manejo diagnóstico- terapéutico en los niños de 1 a 36 meses con fiebre (AU)

Objectives: To determine the clinical characteristics of patients diagnosed with influenza with a rapid test and to study the different management in the Emergency Room with respect to the patients with a negative Influenza test. Methods: Retrospective revision of charts of those patients to whom a test of rapid detection for Influenza was ordered. Results: The test was ordered in 142 patients (median of age of 2.4 months). A positive result for the virus was obtained in 63 patients (44.4%). The main indication for the test was fever with respiratory symptoms (62.7%), followed of fever without source (33.8%). Only one patient with influenza had a positive urine culture; all the blood cultures and CSF cultures were negative. When comparing the patients with a positive test with those with a negative test we do not detect differences in sex, age, high fever or respiratory symptoms. On the other way, the patients with influenza had less respiratory distress (1.6% vs. 17.7%) and more epidemic context at home (54% vs. 31.6%) (<0.01). Patients with a positive test had a lower incidence of admission (19% vs. 57%), received less chest x-rays (30.2% vs. 51.9%) and less antibiotics (14.3% vs. 40.5%). In the sub-group of 25 patients younger than 1 month we did not find any differences. Conclusions: Patients with a positive Influenza test present small clinical differences with respect to those with a negative test. Rapid Influenza test in the Emergency setting modifies the classic management of febrile children aged 1 to 36 months (AU)

Propuesta de actuación ante la sospecha de la ingesta accidental de un paquete con droga (“Body packing”) / An intervention proposal in the presence of suspected accidental drug packet intake (body packing)

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