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1.
An. pediatr. (2003. Ed. impr.) ; 92(1): 37-45, ene. 2020. tab
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-4022

RESUMO

Objetivo: Describir las características de los pacientes pediátricos con sospecha de intoxicación atendidos por unidades de soporte vital avanzado (SVA) y evaluar los indicadores de calidad (IC) para la atención urgente prehospitalaria de estos pacientes. Método: Estudio observacional de los pacientes menores de 18 años con exposición a tóxicos, que fueron atendidos por una unidad de SVA del Sistema de Emergencias Médicas en Cataluña, durante un año. Se definieron criterios de clínica grave. Se evaluaron 8 IC para la atención urgente prehospitalaria de los pacientes pediátricos intoxicados. Resultados: Se incluyó a 254 pacientes. La edad mediana fue de 14 años (p25-75 = 7-16), con exposición intencionada en el 50,8% de los casos. El tóxico más frecuentemente implicado fue el monóxido de carbono (CO) (33,8%). Presentó clínica de toxicidad el 48,8%, siendo grave en el 16,5%. La intencionalidad (OR 5,1; intervalo de confianza del 95%: 1,9-13,8) y el desconocimiento del tiempo transcurrido desde el contacto (OR 3,1; intervalo de confianza del 95%: 1,3-7,3) fueron factores de riesgo independientes asociados a clínica grave. Cinco IC no alcanzaron el estándar de calidad: disponibilidad de guías de actuación específicas, administración de carbón activado en pacientes seleccionados, aplicación de oxigenoterapia a la máxima concentración posible en intoxicación por CO, valoración electrocardiográfica en pacientes expuestos a sustancias cardiotóxicas y registro del conjunto mínimo de datos. Conclusiones: Los pacientes pediátricos expuestos a tóxicos y atendidos por unidades SVA presentan características propias. Destacan la implicación del CO y de los adolescentes con intoxicaciones voluntarias. La evaluación de los IC ha sido útil para detectar puntos débiles en la calidad asistencial de estos pacientes y desarrollar estrategias de mejora


Objective: To describe the characteristics of paediatric patients with suspected poisoning treated by advanced life support (ALS) units, and to evaluate quality indicators (QI) for the prehospital emergency care of these patients. Method: A one-year observational study of patients under 18 years of age exposed to poisoning and treated by an ALS unit of the Medical Emergency System in Catalonia. Severe clinical criteria were defined, with 8 QI being evaluated for prehospital emergency care of poisoned paediatric patients. Results: The study included a total of 254 patients, with a median age of 14 years-old (p25-75 = 7-16), with intentional poisoning in 50.8% of cases. The most frequently involved toxic agent was carbon monoxide (CO) (33.8%). Poisoning was found in 48.8% of those patients, being serious in 16.5%. Intentionally (OR 5.1; 95% CI: 1.9-13.8) and knowledge of the time of exposure (OD 3.1; 95% CI: 1.3-7.3) were independent risk factors associated with the appearance of severe clinical symptoms. Five QI did not reach the quality standard and included, availability of specific clinical guidelines, activated charcoal administration in selected patients, oxygen therapy administration at maximum possible concentration in carbon monoxide poisoning, electrocardiographic assessment in patients exposed to cardiotoxic substances, and recording of the minimum data set. Conclusions: Paediatric patients attended by ALS units showed specific characteristics, highlighting the involvement of CO and adolescents with voluntary poisoning. The QI assessment was useful to detect weak points in the quality of care of these patients and to develop strategies for improvement

2.
An Pediatr (Barc) ; 92(1): 37-45, 2020 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-31129026

RESUMO

OBJECTIVE: To describe the characteristics of paediatric patients with suspected poisoning treated by advanced life support (ALS) units, and to evaluate quality indicators (QI) for the prehospital emergency care of these patients. METHOD: A one-year observational study of patients under 18 years of age exposed to poisoning and treated by an ALS unit of the Medical Emergency System in Catalonia. Severe clinical criteria were defined, with 8 QI being evaluated for prehospital emergency care of poisoned paediatric patients. RESULTS: The study included a total of 254 patients, with a median age of 14 years-old (p25-75 = 7-16), with intentional poisoning in 50.8% of cases. The most frequently involved toxic agent was carbon monoxide (CO) (33.8%). Poisoning was found in 48.8% of those patients, being serious in 16.5%. Intentionally (OR 5.1; 95% CI: 1.9-13.8) and knowledge of the time of exposure (OD 3.1; 95% CI: 1.3-7.3) were independent risk factors associated with the appearance of severe clinical symptoms. Five QI did not reach the quality standard and included, availability of specific clinical guidelines, activated charcoal administration in selected patients, oxygen therapy administration at maximum possible concentration in carbon monoxide poisoning, electrocardiographic assessment in patients exposed to cardiotoxic substances, and recording of the minimum data set. CONCLUSIONS: Paediatric patients attended by ALS units showed specific characteristics, highlighting the involvement of CO and adolescents with voluntary poisoning. The QI assessment was useful to detect weak points in the quality of care of these patients and to develop strategies for improvement.

3.
An. pediatr. (2003. Ed. impr.) ; 90(4): 207-212, abr. 2019. graf, tab
Artigo em Espanhol | IBECS-Express | ID: ibc-ET2-3864

RESUMO

Introducción: La ingesta de cáusticos es la causa más frecuente de consulta tras el contacto con un producto doméstico. Un grupo de pacientes podría considerarse de bajo riesgo y no recibir corticoides parenterales ni realizársele endoscopia, procedimiento considerado terapéuticamente agresivo, sobre todo en la edad pediátrica. Objetivo: Evaluar la seguridad y el beneficio de un protocolo menos agresivo en los pacientes definidos de bajo riesgo. Material y métodos: Estudio analítico-observacional de los pacientes que consultaron por ingesta de cáustico entre enero de 2011 y diciembre de 2015. Se diferenciaron 2 periodos según el protocolo vigente. Periodo-1: protocolo habitual (incluido ingreso y administración de corticoide-antibiótico parenteral) y periodo-2: protocolo menos agresivo en los pacientes de bajo riesgo (prueba de tolerancia oral tras 6 h y alta hospitalaria si persistían asintomáticos). Se consideraron de bajo riesgo si se cumplían todos los criterios: ingesta involuntaria, ausencia de síntomas y lesiones orales. En el resto de pacientes se mantuvo el protocolo habitual. Se consideró como complicación el reingreso con diagnóstico de lesiones digestivas. Resultados: Se incluyeron 48 pacientes en el periodo 1 y 35 en el periodo 2. En el periodo 2 cumplían criterios de bajo riesgo 13 pacientes. La adherencia al protocolo menos agresivo fue del 100%. Ningún paciente de bajo riesgo precisó ingreso tras el alta ni realización de endoscopia. En el periodo 1 la adherencia al protocolo habitual fue del 60,4%. Seis pacientes se habrían beneficiado de la aplicación del protocolo menos agresivo. Conclusiones: Adoptar una actitud más conservadora en los pacientes de bajo riesgo es seguro. Estos pacientes se benefician de la realización de una observación clínica, obviando medidas más agresivas con posibles efectos iatrogénicos secundarios


Introduction: The ingestion of a caustic agent is the most common cause of admission after being in contact with a domestic product. A group of patients could be considered low risk and not require aggressive procedures such a corticosteroid administration and endoscopy, especially in the paediatric population. Objective: To evaluate the safety and benefit of a less aggressive protocol for patients defined as low risk. Material and methods: An analytical-observational study conducted on patients who consulted for caustic ingestion between January 2011 and December 2015. Two periods were differentiated according to the current protocol. Period-1: usual protocol (which included admission and parenteral corticosteroid and antibiotic administration) and Period-2: less aggressive protocol for the low risk patients (oral intake test after 6 hours and discharged if they remained asymptomatic). Low risk patients were considered as those who met the following criteria: unintentional intake, absence of symptoms and oral lesions. In the rest of the patients the usual protocol was performed. Re-admission with a diagnosis of digestive lesions was considered as a complication. Results: Forty-eight patients were included in period 1, and 35 in period 2. In period 2, thirteen patients met low risk criteria. The adherence to the less aggressive protocol was 100%. None of the low risk patients required admission or endoscopy after discharge. In period 1 the adherence to the usual protocol was 60.4%. Six patients would have benefited from the application of the less aggressive protocol. Conclusions: Adopting a more conservative attitude in low risk patients is safe. These patients benefit from clinical observation, without performing more aggressive measures with their possible iatrogenic adverse effects

6.
An Pediatr (Barc) ; 90(4): 207-212, 2019 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-29666025

RESUMO

INTRODUCTION: The ingestion of a caustic agent is the most common cause of admission after being in contact with a domestic product. A group of patients could be considered low risk and not require aggressive procedures such a corticosteroid administration and endoscopy, especially in the paediatric population. OBJECTIVE: To evaluate the safety and benefit of a less aggressive protocol for patients defined as low risk. MATERIAL AND METHODS: An analytical-observational study conducted on patients who consulted for caustic ingestion between January 2011 and December 2015. Two periods were differentiated according to the current protocol. Period-1: usual protocol (which included admission and parenteral corticosteroid and antibiotic administration) and Period-2: less aggressive protocol for the low risk patients (oral intake test after 6hours and discharged if they remained asymptomatic). Low risk patients were considered as those who met the following criteria: unintentional intake, absence of symptoms and oral lesions. In the rest of the patients the usual protocol was performed. Re-admission with a diagnosis of digestive lesions was considered as a complication. RESULTS: Forty-eight patients were included in period 1, and 35 in period 2. In period 2, thirteen patients met low risk criteria. The adherence to the less aggressive protocol was 100%. None of the low risk patients required admission or endoscopy after discharge. In period 1 the adherence to the usual protocol was 60.4%. Six patients would have benefited from the application of the less aggressive protocol. CONCLUSIONS: Adopting a more conservative attitude in low risk patients is safe. These patients benefit from clinical observation, without performing more aggressive measures with their possible iatrogenic adverse effects.


Assuntos
Corticosteroides/administração & dosagem , Cáusticos/envenenamento , Endoscopia/métodos , Guias de Prática Clínica como Assunto , Antibacterianos/administração & dosagem , Pré-Escolar , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Fatores de Risco , Fatores de Tempo
7.
Emergencias (Sant Vicenç dels Horts) ; 30(6): 408-411, dic. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-179711

RESUMO

El aumento en el consumo de cannabis y su trivialización por la población adulta se han traducido en un aumento de los casos de intoxicaciones agudas en niños. Se presenta un estudio observacional retrospectivo de los pacientes menores de 3 años intoxicados por cannabis entre 2012 y 2017 en un servicio de urgencias pediátricas (SUP). Se recogieron datos epidemiológicos, clínicos y toxicológicos. Se detectaron 10 intoxicaciones por cannabis. Nueve pacientes presentaron alteración en el nivel de conciencia. Solo en 2 casos la familia refirió la exposición al tóxico en la anamnesis inicial. La detección en cabello demostró exposición repetida en 2 pacientes. En conclusión, es necesario incluir la intoxicación por cannabis dentro del diagnóstico diferencial de los niños con clínica neurológica aguda no filiada. Ante la detección de cannabis en orina en el SUP, se debe solicitar la confirmación mediante técnicas específicas y valorar la posibilidad de exposiciones repetidas


The increased use of cannabis among adults and the general perception that cannabis is harmless has been accompanied by a rise in the number of acute poisoning cases among children. We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017. Epidemiologic and clinical data as well as toxicologic findings are reported. We found 10 cases of cannabis poisoning in our records. Nine of the patients had diminished consciousness. Only 2 families initially reported exposure to cannabis when interviewed. Repeated exposure was demonstrated by analysis of hair from 2 patients. We conclude that cannabis poisoning should be included in the differential diagnosis of young children with acute neurologic symptoms of unknown origin. When cannabis is detected in urine samples collected in the pediatric emergency department, more specific diagnostic techniques should be used to assess the possibility of repeated exposure


Assuntos
Humanos , Masculino , Feminino , Lactente , Cannabis/envenenamento , Assistência Ambulatorial , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Drogas Ilícitas/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias , Estudos Retrospectivos , Estudo Observacional , Criança , Imunoensaio/métodos
8.
Med. clín (Ed. impr.) ; 150(1): 16-19, ene. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-169654

RESUMO

Antecedentes y objetivo: Los antídotos pueden tener un papel relevante en el tratamiento de las intoxicaciones y el tiempo hasta su administración puede condicionar la supervivencia del paciente. Pacientes y método: Estudio realizado mediante cuestionario a principios del año 2015 en 70 hospitales de Cataluña que atienden urgencias. La disponibilidad cualitativa para cada antídoto se consideró adecuada cuando estaba presente en al menos el 80% de los hospitales. La disponibilidad cuantitativa se consideró adecuada cuando se disponía de la cantidad recomendada en al menos el 80% de los hospitales del nivel oportuno. Resultados: Para hospitales de menor complejidad, el porcentaje de antídotos con disponibilidad cualitativa y cuantitativa adecuada fue del 66,7 y 42,9%. En hospitales de mayor complejidad, las disponibilidades cualitativas y cuantitativas fueron adecuadas en un 64,5 y 38,7% de los antídotos. No se observaron diferencias significativas entre las diferentes regiones sanitarias, pero hubo una correlación positiva (p<0,05) entre las urgencias atendidas por los hospitales y el porcentaje de disponibilidad cualitativa adecuada. Conclusiones: La disponibilidad de antídotos en los hospitales de Cataluña es en general baja y muestra diferencias en función de la región sanitaria y de la complejidad asistencial de los hospitales (AU)


Background and objective: Antidotes may have a relevant role in acute intoxication management and the time until its administration can influence patient survival. Patients and method: Study conducted by a questionnaire sent in early 2015 to 70 hospitals in Catalonia providing emergency services. Qualitative availability on each antidote was considered adequate when present in at least 80% of hospitals. The quantitative availability was considered adequate when at least 80% of hospitals had the number of units of antidote recommended. Results: Lower complexity hospitals (level A) showed a percentage of adequate qualitative and quantitative availability of 66.7 and 42.9% respectively. In higher complexity hospitals (level B) qualitative and quantitative availability was adequate in 64.5 and 38.7% of the antidotes respectively. Data showed no differences between the different health regions as well as a positive correlation (p<.05) between the number of emergencies attended and the percentage of adequate qualitative availability. Conclusions: The availability of antidotes in Catalonia hospitals is generally low and shows differences across health regions and depending on level of complexity (AU)


Assuntos
Humanos , Antídotos/provisão & distribução , Hospitais/normas , Serviços Médicos de Emergência/tendências , Kit Médico de Emergência , Envenenamento/epidemiologia , Envenenamento/prevenção & controle , Administração Hospitalar/normas , Inquéritos e Questionários , Aprovisionamento , Estudos Transversais/métodos
9.
An. pediatr. (2003. Ed. impr.) ; 88(1): 19-23, ene. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-170639

RESUMO

Objetivo: Describir las situaciones en las que se solicita cribado toxicológico en orina desde un servicio de urgencias pediátricas. Determinar si la prueba es potencialmente útil, si conlleva un cambio en el manejo del paciente y si los resultados se comprueban mediante técnicas específicas. Metodología: Estudio retrospectivo de los pacientes menores de 18 años atendidos en urgencias durante el año 2014 a los que se solicitó cribado de tóxicos en orina. Se definieron 2 grupos en función de la potencial capacidad de modificar el manejo del paciente (potencial utilidad y ausencia de utilidad). Resultados: Se recogieron 161 pacientes. En 87 casos (54,0%) el cribado de tóxicos se consideró sin potencial utilidad. En 55 pacientes (34,1%) la falta de utilidad fue debida a que la anamnesis ya explicaba la sintomatología presente, en 29 (18,0%) a que el paciente se encontraba asintomático y en 3 (1,9%) a la sospecha de intoxicación por una sustancia no detectable mediante esta técnica. El resultado ocasionó un cambio de manejo en 5 casos (3,1%). Se detectó algún tóxico en 44 pacientes (27,3%). Se solicitó confirmación con técnicas específicas en 2 (1,2%). Ambos fueron falsos positivos. Conclusiones: La mayor parte de los cribados de tóxicos solicitados no están justificados y es infrecuente que condicionen un cambio en el manejo del paciente. La confirmación mediante técnicas específicas es inusual. Su uso debe restringirse a casos concretos y, siempre que pueda tener repercusiones legales o el paciente niegue el consumo, debe seguirse de un estudio toxicológico específico que aporte un resultado concluyente (AU)


Objective: To describe the situations in which urine drug screening is used in a Paediatric Emergency Department (ED). An analysis is also made on its potential usefulness on whether it changes the patient management, and if the results are confirmed by using specific techniques. Methodology: A retrospective study was conducted on patients under the age of 18 attended in the ED during 2014 and in whom urine drug screening was requested. Depending on the potential capacity of the screening result to change patient management, two groups were defined (potentially useful and not potentially useful). Results: Urine drug screening was performed on a total of 161 patients. The screening was considered not to be potentially useful in 87 (54.0%). This was because the clinical history already explained the symptoms the patient had in 55 (34.1%) patients, in 29 (18.0%) because the patient was asymptomatic, and in 3 (1.9%) because the suspected drug was not detectable in the screening. The drug screening results changed the patient management in 5 (3.1%) cases. A toxic substance was detected in 44 (27.3%). Two out of the 44 that were positive (2.1%) were re-tested by specific techniques, and presence of the toxic substance was ruled out in both of them (false positives). Conclusions: Most of the drug screening tests are not justified, and it is very infrequent that they change patient management. It is very rare that the results are confirmed using more specific methods. Urine drug screening tests should be restricted to particular cases and if the result has legal implications, or if the patient denies using the drug, it should be followed by a specific toxicological study to provide a conclusive result (AU)


Assuntos
Humanos , Criança , Adolescente , Programas de Rastreamento/análise , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Detecção do Abuso de Substâncias/métodos , Drogas Ilícitas/urina , Serviços Médicos de Emergência/métodos , Substâncias Tóxicas , Procedimentos Desnecessários/estatística & dados numéricos
10.
An Pediatr (Barc) ; 88(1): 19-23, 2018 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-28279691

RESUMO

OBJECTIVE: To describe the situations in which urine drug screening is used in a Paediatric Emergency Department (ED). An analysis is also made on its potential usefulness on whether it changes the patient management, and if the results are confirmed by using specific techniques. METHODOLOGY: A retrospective study was conducted on patients under the age of 18 attended in the ED during 2014 and in whom urine drug screening was requested. Depending on the potential capacity of the screening result to change patient management, two groups were defined (potentially useful and not potentially useful). RESULTS: Urine drug screening was performed on a total of 161 patients. The screening was considered not to be potentially useful in 87 (54.0%). This was because the clinical history already explained the symptoms the patient had in 55 (34.1%) patients, in 29 (18.0%) because the patient was asymptomatic, and in 3 (1.9%) because the suspected drug was not detectable in the screening. The drug screening results changed the patient management in 5 (3.1%) cases. A toxic substance was detected in 44 (27.3%). Two out of the 44 that were positive (2.1%) were re-tested by specific techniques, and presence of the toxic substance was ruled out in both of them (false positives). CONCLUSIONS: Most of the drug screening tests are not justified, and it is very infrequent that they change patient management. It is very rare that the results are confirmed using more specific methods. Urine drug screening tests should be restricted to particular cases and if the result has legal implications, or if the patient denies using the drug, it should be followed by a specific toxicological study to provide a conclusive result.


Assuntos
Envenenamento/diagnóstico , Envenenamento/urina , Detecção do Abuso de Substâncias/métodos , Adolescente , Criança , Emergências , Serviço Hospitalar de Emergência , Feminino , Hospitais Pediátricos , Humanos , Masculino , Estudos Retrospectivos , Urinálise
11.
Med Clin (Barc) ; 150(1): 16-19, 2018 Jan 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28705416

RESUMO

BACKGROUND AND OBJECTIVE: Antidotes may have a relevant role in acute intoxication management and the time until its administration can influence patient survival. PATIENTS AND METHOD: Study conducted by a questionnaire sent in early 2015 to 70 hospitals in Catalonia providing emergency services. Qualitative availability on each antidote was considered adequate when present in at least 80% of hospitals. The quantitative availability was considered adequate when at least 80% of hospitals had the number of units of antidote recommended. RESULTS: Lower complexity hospitals (level A) showed a percentage of adequate qualitative and quantitative availability of 66.7 and 42.9% respectively. In higher complexity hospitals (level B) qualitative and quantitative availability was adequate in 64.5 and 38.7% of the antidotes respectively. Data showed no differences between the different health regions as well as a positive correlation (p<.05) between the number of emergencies attended and the percentage of adequate qualitative availability. CONCLUSIONS: The availability of antidotes in Catalonia hospitals is generally low and shows differences across health regions and depending on level of complexity.


Assuntos
Antídotos/provisão & distribução , Serviço Hospitalar de Emergência , Recursos em Saúde/provisão & distribução , Estudos Transversais , Hospitais , Humanos , Espanha
12.
Emergencias ; 30(6): 408-411, 2018.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30638345

RESUMO

EN: The increased use of cannabis among adults and the general perception that cannabis is harmless has been accompanied by a rise in the number of acute poisoning cases among children. We present a retrospective, descriptive study of patients aged 3 years or younger who were treated for cannabis poisoning in a pediatric emergency department between 2012 and 2017. Epidemiologic and clinical data as well as toxicologic findings are reported. We found 10 cases of cannabis poisoning in our records. Nine of the patients had diminished consciousness. Only 2 families initially reported exposure to cannabis when interviewed. Repeated exposure was demonstrated by analysis of hair from 2 patients. We conclude that cannabis poisoning should be included in the differential diagnosis of young children with acute neurologic symptoms of unknown origin. When cannabis is detected in urine samples collected in the pediatric emergency department, more specific diagnostic techniques should be used to assess the possibility of repeated exposure.


Assuntos
Cannabis/envenenamento , Envenenamento/diagnóstico , Envenenamento/epidemiologia , Fatores Etários , Pré-Escolar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Espanha/epidemiologia
13.
An. pediatr. (2003. Ed. impr.) ; 87(5): 284-288, nov. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-168555

RESUMO

Introducción: La prevención es fundamental en las intoxicaciones pediátricas, especialmente cuando se detectan episodios repetidos. Los objetivos de este trabajo son determinar la tasa de recurrencias en la consulta por sospecha de intoxicación, evaluar en qué casos se indican medidas preventivas específicas y conocer si la creación de un ítem para episodios previos en la historia informatizada facilita su detección. Material y métodos: Estudio retrospectivo. Se incluyen los pacientes < 18 años atendidos en un servicio de urgencias por sospecha de intoxicación en 2013 y 2014; se dividen en 2 grupos según la existencia o no de consultas previas por el mismo motivo. Desde enero de 2014 este dato se registra sistemáticamente en el formulario de la anamnesis del episodio de urgencias para el paciente intoxicado mediante un ítem específico. Se comparan las medidas preventivas adoptadas entre ambos grupos. Resultados: Se registraron 731 consultas por sospecha de intoxicación. En el 9% se detectaron antecedentes de episodios previos. En el grupo de pacientes con episodios repetidos se cumplimentó parte de lesiones y se realizó seguimiento con mayor frecuencia que en los pacientes sin episodios previos (28,8% vs 18,0%, p = 0,034 y 65,2% vs 18,8%, p < 0,001, respectivamente). En 2013 la tasa de recurrencia fue del 5,9%, y en 2014 del 12% (p = 0,004). Conclusiones: En un número considerable de pacientes atendidos por sospecha de intoxicación se detectan episodios previos. Aunque en estos pacientes se indican con más frecuencia medidas preventivas, su aplicación es baja. La creación de un ítem específico en la historia informatizada para episodios previos facilita su detección (AU)


Introduction: Prevention is an essential aspect in paediatric poisonings, especially when recurrent episodes are detected. The aims of this article are to detect the recurrence rate for suspected poisoning in emergency consultations, as well as to identify the cases in which specific preventive measures are indicated, and to determine whether the creation of a specific item for recurrent episodes in the computerised medical records system facilitates its detection. Material and methods: A retrospective study was conducted on patients less than 18 years of age treated in the emergency room due to suspected poisoning during 2013 and 2014. Patients were divided according to the presence or absence of previous episodes. From January 2014, a specific item is present in the computerised medical records of the poisoned patient, where the history of previous episodes is registered. The preventive measures used between both groups were compared. Results: A total of 731 consultations were recorded for suspected poisoning. A history of previous episodes was detected in 9% of cases. Medical injury reports and follow-up in outpatient clinics were more often performed in patients with recurrent episodes than in patients without them (28.8% vs 18.0%, P = .034, and 65.2% vs. 18.8%, P < .001, respectively). In 2013, the recurrence rate was 5.9% vs 12% in 2014 (P = .004). Conclusions: The recurrence rate observed is significant. Although preventive measures are more frequently indicated in these patients, their application is low. The creation of a specific item for recurrent episodes in a computerised medical records system facilitates their detection (AU)


Assuntos
Humanos , Criança , Adolescente , Envenenamento/epidemiologia , Readmissão do Paciente/legislação & jurisprudência , Substâncias Perigosas/análise , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Overdose de Drogas/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Estudos Retrospectivos , Recidiva , Serviço Hospitalar de Emergência/estatística & dados numéricos , Envenenamento/etiologia
14.
Farm. hosp ; 41(3): 317-333, mayo-jun. 2017. ilus, tab, mapas
Artigo em Inglês | IBECS | ID: ibc-162871

RESUMO

Objective: To design a virtual antidote network between hospitals that could help to locate on-line those hospitals that stocked those antidotes with the highest difficulty in terms of availability, and ensured that the medication was loaned in case of necessity. Methods: The application was developed by four hospital pharmacists and two clinical toxicologists with the support of a Healthcare Informatics Consultant Company. Results: The antidotes network in Catalonia, Spain, was launched in July 2015. It can be accessed through the platform: www.xarxaantidots.org. The application has an open area with overall information about the project and the option to ask toxicological questions of non-urgent nature. The private area is divided into four sections: 1) Antidotes: data of interest about the 15 antidotes included in the network and their recommended stock depending on the complexity of the hospital, 2) Antidote stock management: virtual formulary, 3) Loans: location of antidotes through the on-line map application Google Maps, and virtual loan request, and 4) Documentation: As of June, 2016, 40 public and private hospitals have joined the network, from all four provinces of Catalonia, which have accessed the private area 2102 times, requested two loans of silibinin, one of hydroxocobalamin, three of antiophidic serum and three of botulism antitoxin. Thirteen toxicological consultations have been received. Conclusions: The implementation of this network improves the communication between centers that manage poisoned patients, adapts and standardizes the stock of antidotes in hospitals, speeds up loans if necessary, and improves the quality of care for poisoned patients (AU)


Objetivo: Diseñar una red virtual de antídotos entre hospitales que permitiese localizar, de forma online, en qué hospitales están ubicados los antídotos con mayor dificultad de disponibilidad y facilitase el préstamo de la medicación en caso de necesidad. Método: La aplicación fue desarrollada por cuatro farmacéuticos de hospital, dos toxicólogos clínicos y el soporte de una empresa informática. Resultados: La red de antídotos de Cataluña entró en funcionamiento en julio de 2015. Puede accederse a través de la plataforma: www.xarxaantidots.org. La aplicación consta de una zona abierta con información general del proyecto y la posibilidad de realizar consultas toxicológicas de carácter no urgente. La zona privada se divide en cuatro secciones: 1) Antídotos: datos de interés de los 15 antídotos en red y dotación recomendada en función de la complejidad del hospital, 2) Gestión del stock de antídotos: botiquines virtuales, 3) Préstamos: localización de antídotos mediante el servidor de aplicaciones de mapas en la web, Google Maps, y solicitud de préstamo virtual y 4) Documentación: Hasta junio de 2016 son 40 los hospitales públicos y privados de las cuatro provincias de Cataluña adheridos; se han registrado 2.102 accesos a la zona privada, solicitado dos préstamos de silibinina, uno de hidroxocobalamina, tres de suero antiofídico y tres de suero antibotulínico. Se han recibido 13 consultas toxicológicas. Conclusiones: La puesta en marcha de la red mejora la comunicación entre centros que atienden a pacientes intoxicados, adecua y homogeneiza la dotación de antídotos de los hospitales, agiliza los préstamos en caso necesario y aumenta la calidad de la atención a los pacientes intoxicados (AU)


Assuntos
Humanos , Antídotos/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Envenenamento/tratamento farmacológico , Redes de Comunicação de Computadores/organização & administração , Envenenamento/epidemiologia , Sistemas de Comunicação no Hospital/organização & administração
15.
Farm Hosp ; 41(3): 317-333, 2017 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-28478747

RESUMO

Objetive: To design a virtual antidote network between hospitals that could help to locate on-line those hospitals that stocked those antidotes with the highest difficulty in terms of availability, and ensured that the medication was loaned in case of necessity. METHODS: The application was developed by four hospital pharmacists and two clinical toxicologists with the support of a Healthcare Informatics Consultant Company. RESULTS: The antidotes network in Catalonia, Spain, was launched in July 2015. It can be accessed through the platform: www.xarxaantidots.org. The application has an open area with overall information about the project and the option to ask toxicological questions of non-urgent nature. The private area is divided into four sections: 1) Antidotes: data of interest about the 15 antidotes included in the network and their recommended stock depending on the complexity of the hospital, 2) Antidote stock management: virtual formulary, 3) Loans: location of antidotes through the on-line map application Google Maps, and virtual loan request, and 4) Documentation: As of June, 2016, 40 public and private hospitals have joined the network, from all four provinces of Catalonia, which have accessed the private area 2 102 times, requested two loans of silibinin, one of hydroxocobalamin, three of antiophidic serum and three of botulism antitoxin. Thirteen toxicological consultations have been received. CONCLUSIONS: The implementation of this network improves the communication between centers that manage poisoned patients, adapts and standardizes the stock of antidotes in hospitals, speeds up loans if necessary, and improves the quality of care for poisoned patients.


Assuntos
Antídotos/provisão & distribução , Serviço de Farmácia Hospitalar/organização & administração , Comunicação , Simulação por Computador , Serviço Hospitalar de Emergência , Formulários de Hospitais como Assunto , Hospitais , Humanos , Espanha , Inquéritos e Questionários
17.
An Pediatr (Barc) ; 87(5): 284-288, 2017 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-28223070

RESUMO

INTRODUCTION: Prevention is an essential aspect in paediatric poisonings, especially when recurrent episodes are detected. The aims of this article are to detect the recurrence rate for suspected poisoning in emergency consultations, as well as to identify the cases in which specific preventive measures are indicated, and to determine whether the creation of a specific item for recurrent episodes in the computerised medical records system facilitates its detection. MATERIAL AND METHODS: A retrospective study was conducted on patients less than 18 years of age treated in the emergency room due to suspected poisoning during 2013 and 2014. Patients were divided according to the presence or absence of previous episodes. From January 2014, a specific item is present in the computerised medical records of the poisoned patient, where the history of previous episodes is registered. The preventive measures used between both groups were compared. RESULTS: A total of 731 consultations were recorded for suspected poisoning. A history of previous episodes was detected in 9% of cases. Medical injury reports and follow-up in outpatient clinics were more often performed in patients with recurrent episodes than in patients without them (28.8% vs 18.0%, P=.034, and 65.2% vs. 18.8%, P<.001, respectively). In 2013, the recurrence rate was 5.9% vs 12% in 2014 (P=.004). CONCLUSIONS: The recurrence rate observed is significant. Although preventive measures are more frequently indicated in these patients, their application is low. The creation of a specific item for recurrent episodes in a computerised medical records system facilitates their detection.


Assuntos
Envenenamento/epidemiologia , Envenenamento/prevenção & controle , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco
19.
An. pediatr. (2003. Ed. impr.) ; 85(1): 13-17, jul. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-154194

RESUMO

Introducción: La tentativa de suicidio en adolescentes es un grave problema de salud a nivel mundial. Para desarrollar medidas preventivas es necesario identificar factores de riesgo. El objetivo del estudio es describir y analizar las características epidemiológicas y clínicas de los pacientes que acuden al Servicio de Urgencias Pediátrico (SUP) tras presentar una tentativa de suicidio. Materiales y métodos: Estudio retrospectivo de los pacientes menores de 18 años visitados en un SUP tras tentativa de suicidio entre 2008 y 2012. Resultados: Se obtuvo una muestra de 241 pacientes, 84,2% mujeres, con una mediana de edad de 15,6 años. El 65,1% de los pacientes presentaba antecedentes psiquiátricos, siendo el más frecuente el trastorno depresivo (61 pacientes). El mecanismo suicida más frecuente fue la intoxicación medicamentosa con 94,2% de los casos. La presencia de ideación suicida estable previamente a la tentativa fue más frecuente en los varones y en pacientes con tentativas previas, y se relacionó con la aparición de secuelas en mayor proporción. Además, en los pacientes con intoxicación se relacionó también con presentar antecedentes psiquiátricos y con la aparición de clínica de toxicidad. Conclusiones: Los pacientes varones, con antecedentes psiquiátricos, con antecedentes de tentativas suicidas previas y/o con clínica de toxicidad en el momento de atención en el SUP presentan con más frecuencia ideación suicida estable previa a la realización de la tentativa y, por tanto, mayor gravedad y riesgo de repetirla. Requieren, por tanto, una valoración psiquiátrica cuidadosa y un seguimiento estrecho (AU)


Introduction: Suicide attempt in adolescents is a major global health problem. In order to prevent them, the risks factors need to be identified. The present study evaluates the clinical and epidemiological aspects of adolescent patients after attempted suicide, who were seen in an emergency department. Materials and methods: Description of retrospective study of patients younger than 18 years who visited emergency department unit after a suicide attempt, during the period from 2008 to 2012. Results: A total of 241 patients were included, of whom 203 were female. The median age of the patients was 15.6 years. Psiquiatric history was present in 65.1% of the patients. The most frequent suicide mechanism was drug overdose (94.2%). Attempted suicide ideation was more common in males and in patients with previous attempts, and were also more related to sequels. Moreover, patients with an overdose were associated with psychiatric history and clinical toxicity. Conclusions: Patients with any of the following characteristics; male, psychiatric history, a history of previous suicide attempts and/or clinical toxicity at the time of the visit in the emergency center, were more associated suicidal ideation before the attempt. Therefore, they had greater severity and risk repeating the attempt. They require a careful psychiatric evaluation and close monitoring (AU)


Assuntos
Humanos , Adolescente , Tentativa de Suicídio/estatística & dados numéricos , Ideação Suicida , Sintomas Comportamentais/epidemiologia , Sintomas Afetivos/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Estudos Retrospectivos , Fatores de Risco
20.
Emergencias (St. Vicenç dels Horts) ; 28(1): 31-37, feb. 2016. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-148464

RESUMO

Objetivo. Analizar el impacto de la aplicación de medidas de mejora implementadas a partir de la evaluación de indicadores de calidad (IC) en la atención prestada a los pacientes pediátricos con intoxicación aguda. Método. Se compara el resultado actual de los IC con el estándar deseado y con el resultado obtenido en dos estudios previos. Estudio-1: evaluación de 6 IC básicos en los servicios de urgencias pediátricas (SUP) participantes en el Grupo de Trabajo de Intoxicaciones de la Sociedad Española de Urgencias Pediátricas (GTI-SEUP). Estudio-2: evaluación de los 20 IC en uno de los servicios de urgencias del GTI-SEUP. Tras la realización de los mismos se implementaron medidas correctoras: grupo de seguimiento de lavado gástrico, reedición del manual de intoxicaciones del GTI-SEUP, implementación del protocolo de atención al paciente intoxicado y creación de campos específicos en la historia clínica informatizada. Resultados. Estudio-1: se alcanza el estándar en 4 IC y mejora la disponibilidad de protocolos (el IC supera el estándar en el 100% de SUP vs el 29,2% previo; p < 0,001) sin cambios significativos en el resto de IC. Estudio-2: se alcanza el estándar en 13 IC y mejora de los IC sobre cumplimentación de parte judicial (44,4% vs 19,2%; p = 0,036), registro del Conjunto Mínimo de Datos (51,0% vs 1,9%; p < 0,001) y tendencia al aumento de administración de carbón activado en las primeras 2 horas (93,1% vs 83,5%; p = 0,099). No existen cambios significativos en el resto de IC. Conclusiones. La implementación de medidas correctoras ha dado lugar a una mejora en el resultado de algunos IC. La calidad de la asistencia de estos pacientes es aún mejorable (AU)


Objective. To analyze the impact of quality-indicator-based measures for improving quality of care for acute poisoning in pediatric emergency departments. Methods. Recent assessments of quality indicators were compared with benchmark targets and with results from previous studies. The first study evaluated 6 basic indicators in the pediatric emergency departments of members of to the working group on poisoning of the Spanish Society of Pediatric Emergency Medicine (GTI-SEUP). The second study evaluated 20 indicators in a single emergency department of GTI-SEUP members. Based on the results of those studies, the departments implemented the following corrective measures: creation of a team for gastric lavage follow-up, preparation of a new GTI-SEUP manual on poisoning, implementation of a protocol for poisoning incidents, and creation of specific poisoning-related fields for computerized patient records. Results. The benchmark targets were reached on 4 quality indicators in the first study. Improvements were seen in the availability of protocols, as indicators exceeded the target in all the pediatric emergency departments (vs 29.2% of the departments in an earlier study, P < .001). No other significant improvements were observed. In the second study the benchmarks were reached on 13 indicators. Improvements were seen in compliance with incident reporting to the police (recently, 44.4% vs 19.2% previously, P = .036), case registration in the minimum basic data set (51.0% vs 1.9%, P < .001), and a trend toward increased administration of activated carbon within 2 hours (93.1% vs 83.5%, P = .099). No other significant improvements were seen. Conclusions. The corrective measures led to improvements in some quality indicators. There is still room for improvement in these emergency departamens’ care of pediatric poisoning (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Envenenamento/epidemiologia , Qualidade da Assistência à Saúde/tendências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/métodos , Indicadores de Qualidade em Assistência à Saúde , Melhoria de Qualidade/tendências
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