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OBJECTIVE: To explore the feasibility and acceptability of a novel hospital-at-home (HaH) program for adolescent patients with a severe eating disorder (ED). METHOD: Retrospective description of the program during its first year of activity. The feasibility construct is based on accessibility, recruitment, rate of retention, avoidance of hospital stays, and management of crisis situations. Caregivers completed a satisfaction questionnaire on discharge, including an item on perceived safety. All patients referred to the program were included. RESULTS: Fifty-nine female patients with a mean age of 14.69 years (SD = 1.67) were admitted. The mean stay was 39.14 days (SD = 14.47). On admission, 32.2% of patients presented nonsuicidal self-harm behavior and 47.5% had comorbid mental disorders. All patients were screened in the first 48 h after referral, and the program retention rate was 91.52%. As for use of health services, 2016.03 hospital stays were avoided, and only 16.12% of the 31 calls received for urgent care required emergency department visits. Families gave the program an overall satisfaction score of 4.95/5, and all described it as "very safe." DISCUSSION: The HaH program described is a feasible and acceptable care model in adolescents with severe EDs and comorbidities. Effectiveness studies should be performed. PUBLIC SIGNIFICANCE: Eating disorders are a major concern for public health. The adolescent HaH program presented marks an advance in intensive community treatments for patients with severe EDs and comorbidities.
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Hospitalização , Hospitais , Humanos , Adolescente , Feminino , Estudos Retrospectivos , Estudos de Viabilidade , Tempo de InternaçãoRESUMO
Infants < 3 months with minor head trauma (MHT) are a particularly vulnerable group, though few studies have focused specifically on these patients. We aimed to evaluate the application of the PECARN prediction rule, designed for clinically important traumatic brain injury (ciTBI) in children < 2 years in infants < 3 months, and create a specific prediction rule for this population. We conducted a prospective multicenter observational study in 13 pediatric emergency departments (PEDs) in Spain. The PECARN rule was applied to all patients. A new specific prediction rule for infants < 3 months of age was created. The main outcome measures were (1) ciTBI, (2) TBI evidenced on computed tomography (CT) scan, and (3) isolated skull fracture (ISF). Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 21,981 children with MHT, 366 (1.7%) were < 3 months old and 195 (53.3%) underwent neuroimaging, including 37 (10.1%) with CT scan. The sensitivity and negative predictive value (NPV) of the PECARN prediction rule for ciTBI were 100% (95% CI, 20.7-100) and 99.7% (95% CI, 98.4-100%), respectively. Of the 230 infants (62.8%) who met the PECARN low-risk criteria, none had ciTBI, 1 (0.4% overall, 95% CI, 0-2.4) had TBI on CT, and 2 (0.9% overall; 95% CI, 0.1-3.1) had an ISF. Among the 136 infants (37.2%) who did not meet the PECARN low-risk criteria, 1 (0.3% overall; 95% CI, 0-1.5) had ciTBI, 11 (8.1% overall; 95% CI, 4.1-14.0) had TBI on CT, and 18 (13.2% overall; 95% CI, 8-20.1) had an ISF. The sensitivity and NPV of the Spanish prediction rule for ciTBI were 100% (95% CI, 20.7-100) and 100% (95% CI, 98.4-100%), respectively. No infants in the registry developed complications during follow-up. CONCLUSION: The PECARN rule for infants < 2 years old accurately identified infants < 3 months old at low risk for ciTBI in our population, although the adapted Spanish rule presented here could be even more accurate. WHAT IS KNOWN: ⢠Infants younger than 3 months are vulnerable to minor blunt head trauma due to their age and to difficulties in assessing the subtle symptoms and minimal physical findings detected on examination. ⢠A low threshold for CT scan is recommended in this population. WHAT IS NEW: ⢠PECARN rule for infants < 2 years old is an adequate tool with which to identify infants < 3 months old at low risk for clinically important traumatic brain injury. ⢠Spanish rule could identify even more low-risk infants without overlooking important outcomes but it should be validated to confirm its predictive capacity.
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Lesões Encefálicas Traumáticas , Criança , Humanos , Lactente , Pré-Escolar , Estudos Prospectivos , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Serviço Hospitalar de Emergência , Valor Preditivo dos Testes , Fatores EtáriosRESUMO
AIM: The immune status of children recovering from SARS-CoV-2 infection is not completely understood. We describe IgG antispike persistence in children infected during the first two pandemic waves. In addition, we compared with healthy controls their leukocyte populations and CD64 expression. METHODS: Cross-sectional study. Carried out from October 2021 to February 2022 in nonreinfected and nonvaccinated children with SARS-CoV-2 in 2020. The presence of antispike IgG was studied using chemiluminescent immunoassay. Leukocyte populations were analysed using flow cytometry and marked for CD45, CD4, CD8 and CD64. Statistical minor than 0.05 was considered significant. RESULTS: One hundred and eighty-three control and 77 patients were included. IgG antispike determinations were performed after a median of 501 days (262-464); 52 of 77 children were positive. Cases showed significantly higher percentages of monocytes, lymphocytes, CD8+ and CD4+ . In addition, CD64 expression was higher in monocytes and neutrophils. The presence of IgG antispike was accompanied by a higher percentage of CD64+ neutrophils. CONCLUSION: In our series, the SARS-CoV-2 IgG antispike protein was usually positive beyond 1 year after infection. Furthermore, leukocyte populations from cases differ from controls, with higher CD64 expression on neutrophils and monocytes. Prospective clinical observations are required to confirm the implications of these findings.
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COVID-19 , SARS-CoV-2 , Humanos , Criança , Estudos Prospectivos , Estudos Transversais , Receptores de IgG/genética , Receptores de IgG/metabolismo , Imunoglobulina G , Anticorpos AntiviraisRESUMO
Specific knowledge of the features of minor head trauma in infants is necessary to develop appropriate preventive strategies and adjust clinical management in pediatric emergency departments (PEDs). The aim of this study is to describe the epidemiology of minor blunt head trauma in infants < 3 months who present to PEDs. We performed a prospective study of infants evaluated in any of 13 Spanish PEDs within 24 h of a minor head trauma (Glasgow Coma Scale scores of 14-15) between May 2017 and November 2020. Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 1,150,255 visits recorded, 21,981 children (1.9%) sustained a head injury, 386 of whom (0.03%) were under 3 months old. Among the 369 patients who met the inclusion criteria (0.03%), 206 (56.3%) were male. The main causes of trauma were fall-related (298; 80.8%), either from furniture (138/298; 46.3%), strollers (92/298; 30.9%), or a caregiver's arms (61/298; 20.5%). Most infants were asymptomatic (317; 85.9%) and showed no signs of injury on physical exam (210; 56.9%). Imaging studies were performed in 195 patients (52.8%): 37 (10.0%) underwent computed tomography (CT) scan, 162 (43.9%) X-ray, and 22 (6.0%) ultrasound. A clinically important traumatic brain injury (ciTBI) occurred in 1 infant (0.3% overall; 95% CI, 0-1.5), TBI was evidenced on CT scan in 12 (3.3% overall; 95% CI, 1.7-5.7), and 20 infants had an isolated skull fracture (5.5% overall; 95% CI, 3.4-8.3). All outcomes were caused by falls onto hard surfaces. CONCLUSION: Most head injuries in infants younger than 3 months are benign, and the rate of ciTBI is low. Prevention strategies should focus on falls onto hard surfaces from furniture, strollers, and caregivers' arms. Optimizing imaging studies should be a priority in this population. WHAT IS KNOWN: ⢠Infants younger than 3 months are vulnerable to minor blunt head trauma due to their age and to difficulties in assessing the subtle symptoms and minimal physical findings detected on examination. ⢠A low threshold for CT scan is recommended in this population. WHAT IS NEW: ⢠Most cases of blunt head trauma in infants younger than 3 months have good outcomes, and the rate of clinically important traumatic brain injury is low. ⢠Optimizing imaging studies should be a priority in this population, avoiding X-ray examinations and reducing unnecessary CT scans.
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Lesões Encefálicas Traumáticas , Traumatismos Cranianos Fechados , Criança , Serviço Hospitalar de Emergência , Feminino , Escala de Coma de Glasgow , Traumatismos Cranianos Fechados/diagnóstico , Traumatismos Cranianos Fechados/epidemiologia , Traumatismos Cranianos Fechados/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos ProspectivosRESUMO
AIM: We investigated prolonged symptoms in children after COVID-19, including the clinical characteristics and risk factors. METHODS: This multicentre retrospective study focused on 451 children under 18 years old who were diagnosed with symptomatic COVID-19 between 14 March and 31 December 2020. Persistent symptoms were analysed with a telephone questionnaire by the attending physicians from 1 August to 30 September 2021. A control group of 98 with no history of COVID-19, who were treated for other reasons, was also included. RESULTS: Most (82.0%) of the cases had mild infections that required outpatient care and 5.1% were admitted to the paediatric intensive care unit (PICU). We found that 18.4% had symptoms that lasted 4-12 weeks. There were also 14.6% who were symptomatic for longer than 12 weeks and the odds risks were higher for children aged 5 years or more (OR 3.0), hospitalised (OR 3.9), admitted to the PICU (OR 4.3) and with relatives who were symptomatic for 12 weeks or more (OR 2.8). The controls had similar percentages of prolonged symptoms, despite having no history of COVID-19, especially those who were older than 5 years. CONCLUSION: This study confirmed that a worrying percentage of children had prolonged symptoms after COVID-19.
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COVID-19 , Adolescente , COVID-19/epidemiologia , Criança , Hospitalização , Humanos , Unidades de Terapia Intensiva Pediátrica , Estudos Retrospectivos , SARS-CoV-2RESUMO
AIM: Procedures normally performed in the hospital setting are increasingly delivered as part of hospital at home (HAH) programmes. The aim of this study is to describe the procedures and diseases treated during the first 2 years of a new paediatric HAH programme. METHODS: This is a retrospective, observational study conducted in the HAH programme of Niño Jesús Children's Hospital (Spain). We included demographic data, diagnosis and procedures delivered to patients admitted to the HAH programme from November 2018 to November 2020. RESULTS: There were 935 admissions of 833 patients. The median age was 5 years (interquartile range 2.3-9.5). Seventy-five percent of patients were previously healthy. The most frequent illnesses were acute infections (37%) (e.g. complicated appendicitis and ENT, genitourinary, skin and soft tissue infections) and acute respiratory diseases (17.3%) (e.g. asthma, bronchiolitis and pneumonia). Thirty-six percent of admissions underwent nocturnal polysomnography. The median length of stay was 4 days (SD 4.9 days). Eight percent of the episodes studied required care in the emergency department due to condition worsening (55.3%) and problems with devices (36.1%). Hospital readmission was required in 5.6% of cases, 42.4% of which later resumed care in the HAH. The estimated daily cost of HAH is 330.65 euros, while the hospital per-day costs of polysomnography, asthma and endovenous therapy are 1899.24, 1402.5, and 976.26 euros. Ninety percent of families reported a high level of satisfaction. CONCLUSIONS: Paediatric HAH programmes are a feasible, cost-effective alternative to hospital care. Further studies should compare the evolution of patients treated in the traditional hospital setting and those in HAH.
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Asma , Serviços de Assistência Domiciliar , Doença Aguda , Criança , Pré-Escolar , Seguimentos , Hospitais , HumanosRESUMO
INTRODUCTION: The most common clinical presentation of neuroblastoma is an abdominal mass, but it can present with uncommon symptoms, such as adrenergic storm due to catecholamine release. OBJECTIVE: To describe an unusual presentation of neuroblastoma and the wide differential diagnosis that exists in an infant with adrenergic symptoms. CLINICAL CASE: A 7-week old female infant was evaluated due to a 3-week history of sweating and irritability associated with a 24-hour fever and respiratory distress. At admission, she presented poor general condition, irritability, sweating, facial redness, tachypnea and skin paleness, extreme sinus tachycardia, and high blood pressure (HBP), interpreted as adrenergic symptoms. The study was completed with abdominal ultrasound and magnetic reso nance imaging that showed a large retroperitoneal mass compatible with neuroblastoma. Plasma and urinary catecholamines tests showed high levels of dopamine, adrenaline, and noradrenaline, probably of tumor origin. We started antihypertensive treatment with alpha-blocker drugs, showing a good blood pressure control. The tumor was surgically resected without incidents and adequate subsequent recovery. The patient presented a favorable evolution after three years of follow-up. Con clusions: In an infant with adrenergic symptoms such as irritability, redness, sweating associated with HBP, it should be ruled out pathology heart or metabolic (hypoglycemia) pathology, intoxications, and/or adrenal pathology. Within this last one, neuroblastoma is the first diagnostic possibility, since it is one of the main tumors in childhood and, although this presentation is not usual, it can produce these symptoms.
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Catecolaminas/urina , Rubor/etiologia , Hipertensão/etiologia , Neuroblastoma/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Sudorese , Taquicardia/etiologia , Biomarcadores Tumorais/urina , Diagnóstico Diferencial , Feminino , Humanos , Hipertensão/diagnóstico , Lactente , Humor Irritável , Neuroblastoma/complicações , Neuroblastoma/urina , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/urina , Taquicardia/diagnósticoRESUMO
OBJECTIVES: Hospital at home (HAH) replaces acute inpatient hospital care for selected patients by providing care in their homes. We sought to describe the characteristics, management, and complications of patients with osteoarticular infections (OAIs) treated in an HAH program and its economic impact. METHODS: We conducted a retrospective observational study evaluating an HAH program in a pediatric hospital in Spain, describing the characteristics of patients with confirmed OAIs requiring intravenous antibiotic therapy admitted to this program between January 2019 and December 2022. The program operates as a virtual ward with possible daily visits by physicians and nurses and 24/7 telephone contact. RESULTS: A total of 88 patients (median age, 4.1 years; interquartile range [IQR], 1.7-10.6) with OIAs were admitted to the HAH program. Osteomyelitis (57%) and septic arthritis (29%) were the most frequent infections. Cefuroxime (42%) and cefazolin (39%) were the most frequently prescribed antibiotics. Caregiver self-administration was performed in 99%, allowing multiple daily doses of antimicrobial therapy, 80% by peripheral line. Thirteen patients (15%) had drug-related adverse events, only 3 requiring drug modification. Two patients (2%) were readmitted during HAH, and 1 was readmitted within 30 days of HAH discharge. The median HAH stay was 7 days (IQR, 4-8.75). For osteomyelitis, hospital days lowered from 8.5 days (IQR, 4.5-12) to 4 days (IQR, 3-7) after HAH implementation (P = .005) with 68% per-patient estimated cost savings. CONCLUSIONS: HAH treatment of OAIs is effective and cost-efficient. Patient support by medical and nursing staff, adequate family training, and regular communication are essential to ensure safe home admission.
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Hospitalização , Osteomielite , Humanos , Criança , Pré-Escolar , Tempo de Internação , Alta do Paciente , Osteomielite/tratamento farmacológico , HospitaisRESUMO
INTRODUCTION: In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. OBJECTIVES: To analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments (PEDs) and the adherence of each hospital to the recommendations of the PECARN rule. POPULATION AND METHODS: We conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020. RESULTS: Of 21 981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%-40.0%), skull X-rays in 162 (44.3 %; range, 0%-100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%-24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%-100%); 37.1% (36/97) classified as intermediate-risk (range, 0%-100%) and 57.4% (132/230) classified as low-risk (range, 0%-100%). CONCLUSION: We found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish PEDs, mainly due to an excessive use of skull X-rays.
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Traumatismos Craniocerebrais , Técnicas de Apoio para a Decisão , Humanos , Criança , Lactente , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/terapia , Serviço Hospitalar de Emergência , Tomografia Computadorizada por Raios X , AlgoritmosRESUMO
A 12-year-old child presented to the emergency department with a right forearm fracture. After administration of an intravenous dose of ketamine for fracture reduction, he developed severe hypertension. This sign led us to discover an undiagnosed coarctation of the aorta.
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Anestésicos Dissociativos/efeitos adversos , Coartação Aórtica/diagnóstico , Traumatismos do Antebraço/cirurgia , Hipertensão/induzido quimicamente , Ketamina/efeitos adversos , Anestésicos Dissociativos/administração & dosagem , Criança , Humanos , Ketamina/administração & dosagem , MasculinoRESUMO
Advances in medical care have increased the survival of children with complex chronic pathology (CCP). OBJECTIVE: to analyze the epidemiological and clinical characteristics of a cohort of children with CCP. PATIENTS AND METHOD: retrospective descriptive study performed in a tertiary hospital bet ween June 2017 and June 2020, which included patients with CCP criteria. Epidemiological, clinical, admissions, and services involved data were collected and analyzed. Statistical analysis was perfor med using SPSS v22.0 software. RESULTS: 323 patients (mean age 7 years) were included. 93.1% had a multisystem disease, with neurological (87.3%) and gastrointestinal (34.1%) as the most frequent chronic conditions. 39.9% were technology dependent. The main diagnoses were Infantile Cerebral Palsy (23.5%) and Epileptic Encephalopathy (13.9%). Each patient was in follow-up by 5 specialists on average. Of the patients, 85.1% were admitted at some time, with a total of 739 admissions. The mean length of stay was 8.7 days. Technology-dependent patients accounted for 54.7% of hospi talizations. The reasons for admission were acute illness (64.3%), surgery (20.3%), and diagnostic procedure (15%). ICU was required in 23.1%. 62 admissions were partially carried out by the Home Hospitalization Unit. CONCLUSIONS: Children with CCP require an increased number of admissions and multiple specialists. The implementation of specialized referral units may be useful to improve their care.
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Hospitalização , Unidades de Terapia Intensiva , Criança , Humanos , Estudos Retrospectivos , HospitaisRESUMO
INTRODUCTION: As of 30 April 2020, 203.715 SARS-CoV-2 infections had been reported in Spain, 54.486 in Madrid, 21.4% were health care workers. Our objective is to determine seroprevalence of COVID-19 among workers in a monographic pediatric hospital. METHODS: Between April13th and 30th, 1.523 health workers were recruited to be tested for SARS-CoV-2 serology screening (All Test®) and they answered a questionnaire with demographic, epidemiological and clinical information and previous exposure to COVID-19. FINDINGS: One thousand two hundred ninety two (84.8%) were tested. Positive serology (IgM and/or IgG) to SARS-CoV-2 was found in 17.2% (222/1.292), in 15.5% (201/1.292) if only IgG was considered. Median age was 44±13 years, 73% were female. The 33.8% (75/222) were asymptomatic. Eighty one had a previous positive rRT-PCR. The 14% (32/222) referred a family contact. CONCLUSION: Serology prevalence for SARS-CoV-2 in workers of a pediatric hospital was higher than in general population. Many of them had an unnoticed infection.
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COVID-19 , SARS-CoV-2 , Adulto , COVID-19/diagnóstico , COVID-19/epidemiologia , Criança , Feminino , Pessoal de Saúde , Hospitais Pediátricos , Humanos , Imunoglobulina G , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Espanha/epidemiologiaRESUMO
INTRODUCTION: In the treatment of patients with acute bronchiolitis there is great variability in clinical practice. Treatments whose efficacy has not been demonstrated are frequently used despite the recommendations contained in the Clinical Practice Guidelines. MATERIAL AND METHODS: A quality improvement strategy is implemented in the care of patients with acute bronchiolitis in the Emergency Department, which is maintained for five years and is periodically updated to be increasingly restrictive regarding the use of bronchodilators. To evaluate the impact of the intervention, a retrospective study of the rates of prescription of bronchodilators in children diagnosed with acute bronchiolitis in the month of December of four epidemic periods (2012, 2014, 2016 and 2018) was carried out. RESULTS: 1767 children are included. There were no differences regarding age, respiratory rate, oxygen saturation or the estimated severity in each of the study seasons. The use of salbutamol in the Emergency Department decreased from 51.2% (95% CI: 46.6-55.8%) in 2012 to 7.8% (95% CI: 5.7%-10.5%) in 2018 (Pâ¯<â¯.001) and epinephrine prescription rates fell from 12.9% (95% CI: 10.1%-16.3%) to 0.2% (95% CI: 0-1.1%) (Pâ¯<â¯.001). At the same time, there was a decrease in the median time of attendance in the Emergency Department and in the admission rate without changing the readmission rate in 72â¯h. CONCLUSIONS: The systematic and continuous deployment over time of actions aimed at reducing the use of salbutamol and epinephrine in the treatment of bronchiolitis, prior to the epidemic period, seems an effective strategy to reduce the use of bronchodilators in the Emergency Department.
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Bronquiolite , Broncodilatadores , Albuterol/uso terapêutico , Bronquiolite/terapia , Broncodilatadores/uso terapêutico , Criança , Epinefrina/uso terapêutico , Humanos , Estudos RetrospectivosRESUMO
INTRODUCTION: Endemic coronaviruses have been found in acute bronchiolitis, mainly as a coinfecting virus. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been responsible for respiratory illness in hospitalized children. The characteristics of patients with bronchiolitis have not been extensively described. METHODS: Cross-sectional study of patients with bronchiolitis and SARS-CoV-2 infection enrolled in a prospective multicenter cohort of children hospitalized with COVID-19 in Spain from March 1, 2020 to February 28, 2021. RESULTS: Twelve of 666 children infected with SARS-CoV-2 who required hospital admission met the diagnostic criteria for bronchiolitis (1.8%). Median age was 1.9 months (range: 0.4-10.1). Six cases had household contact with a confirmed or probable COVID-19 case. Main complaints were cough (11 patients), rhinorrhea (10), difficulty breathing (8), and fever (8). Eleven cases were classified as mild or moderate and one as severe. Laboratory tests performed in seven patients did not evidence anemia, lymphopenia, or high C-reactive protein levels. Chest X-rays were performed in six children, and one case showed remarkable findings. Coinfection with metapneumovirus was detected in the patient with the most severe course; Bordetella pertussis was detected in another patient. Seven patients required oxygen therapy. Albuterol was administered in four patients. One patient was admitted to the pediatric intensive care unit. Median length of admission was 4 days (range: 3-14). No patient died or showed any sequelae at discharge. Two patients developed recurrent bronchospasms. CONCLUSION: SARS-CoV-2 infection does not seem to be a main trigger of severe bronchiolitis, and children with this condition should be managed according to clinical practice guidelines.
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Bronquiolite , COVID-19 , Bronquiolite/complicações , Bronquiolite/epidemiologia , Criança , Criança Hospitalizada , Estudos Transversais , Humanos , Lactente , Estudos Prospectivos , SARS-CoV-2RESUMO
INTRODUCTION: As of 30 April 2020, 203.715 SARS-CoV-2 infections had been reported in Spain, 54.486 in Madrid, 21.4% were health care workers. Our objective is to determine seroprevalence of COVID-19 among workers in a monographic pediatric hospital. METHODS: Between April13th and 30th, 1.523 health workers were recruited to be tested for SARS-CoV-2 serology screening (All Test®) and they answered a questionnaire with demographic, epidemiological and clinical information and previous exposure to COVID-19. FINDINGS: One thousand two hundred ninety two (84.8%) were tested. Positive serology (IgM and/or IgG) to SARS-CoV-2 was found in 17.2% (222/1.292), in 15.5% (201/1.292) if only IgG was considered. Median age was 44±13 years, 73% were female. The 33.8% (75/222) were asymptomatic. Eighty one had a previous positive rRT-PCR. The 14% (32/222) referred a family contact. CONCLUSION: Serology prevalence for SARS-CoV-2 in workers of a pediatric hospital was higher than in general population. Many of them had an unnoticed infection.
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Our study describes more than 100 children hospitalized with pneumonia during lockdown in the first pandemic wave with only 20% attributable to SARS-CoV-2. The serologic study during follow-up only helped to detect 4%. Other etiologies were common. Older age, presence of headache, vomiting, lymphopenia and thrombopenia were associated with COVID-19 pneumonia.
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COVID-19/complicações , Pandemias , Pneumonia/etiologia , SARS-CoV-2/isolamento & purificação , COVID-19/epidemiologia , COVID-19/virologia , Criança , Criança Hospitalizada , Pré-Escolar , Feminino , Hospitais Universitários , Humanos , Lactente , Masculino , Pneumonia/epidemiologia , Pneumonia/virologia , SARS-CoV-2/genética , Espanha/epidemiologia , Centros de Atenção TerciáriaRESUMO
About 80% of patients with tuberous sclerosis complex (TSC) present renal involvement, usually as angiomyolipomas followed by cystic disease. An early diagnosis of polycystic kidney disease (PKD) in such patients is frequently related to the TSC2/PKD1 contiguous gene syndrome (PKDTS). Molecular confirmation of PKDTS is important for a prompt diagnosis, which can be complicated by the phenotypic heterogeneity of PKD and the absence of a clear phenotype-genotype correlation. Herein, we report three PKDTS pediatric patients. The case 3 did not present a classic PKDTS phenotype, having only one observable cyst on renal ultrasound at age 4 and multiple small cysts on magnetic resonance imaging at age 15. In this patient, chromosomal microarray analysis showed a gross deletion of 230.8kb that involved TSC2, PKD1 and 13 other protein-coding genes, plus a heterozygous duplication of a previously undescribed copy number variant of 242.9kb that involved six protein-coding genes, including SSTR5, in the 16p13.3 region. Given the observations that the case 3 presented the mildest renal phenotype, harbored three copies of SSTR5, and the reported inhibition of cystogenesis (specially in liver) observed with somatostatin analogs in some patients with autosomal dominant PKD, it can be hypothesized that other genetic factors as the gene dosage of SSTR5 may influence the PKD phenotype and the progression of the disease; however, future work is needed to examine this possibility.
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Variação Genética , Doenças Renais Policísticas/genética , Canais de Cátion TRPP/genética , Proteína 2 do Complexo Esclerose Tuberosa/genética , Esclerose Tuberosa/genética , Adolescente , Criança , Pré-Escolar , Éxons/genética , Feminino , Deleção de Genes , Humanos , Lactente , Masculino , Fenótipo , Doenças Renais Policísticas/diagnóstico por imagem , Síndrome , Esclerose Tuberosa/diagnóstico por imagemRESUMO
INTRODUCTION: The prevalence and the variability of clinical practice in acute bronchiolitis make it a perfect candidate to monitor the proper use of resources. The aim of this study is to analyse the differences in the use of non-recommended resources in the management of bronchiolitis in the Emergency Department, before and after the establishment of a new protocol. METHODS: A retrospective study was conducted on a sample of patients diagnosed with acute bronchiolitis in the Emergency Department of a tertiary hospital, before (December 2014) and after (December 2016) the implementation of a new protocol. A comparison was made on the use of diagnostic tests and treatments in both groups. RESULTS: The analysis included a total of 113 patients with acute bronchiolitis examined in December 2014, and 128 patients in December 2016. The clinical characteristics in both groups were similar. In the post-protocol period, there was a significant decrease in the use of salbutamol, both in the Emergency Department (33.6% vs 19.5%, P<.01) and at discharge (46.7% vs 15.2%, P<.001); adrenaline (12.4% vs 2.4%, P=.002), and nebulised hypertonic saline solution (5.3% vs 0.8%, P=.04). Rapid respiratory syncytial virus (RSV) testing was also decreased (40.7% vs 26.6%, P=.01). This decrease was not associated with an increase in the number of admissions or re-assessments in the Emergency Department. CONCLUSIONS: The establishment of a new protocol for acute bronchiolitis decreased the use of non-recommended resources, mainly the use of bronchodilators and rapid RSV testing.
Assuntos
Bronquiolite/terapia , Serviço Hospitalar de Emergência/tendências , Fidelidade a Diretrizes/tendências , Padrões de Prática Médica/tendências , Utilização de Procedimentos e Técnicas/tendências , Procedimentos Desnecessários/tendências , Doença Aguda , Bronquiolite/diagnóstico , Bronquiolite/etiologia , Pré-Escolar , Protocolos Clínicos , Terapia Combinada , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , EspanhaRESUMO
Introducción: En la valoración de los lactantes menores de 3 meses con un traumatismo craneoencefálico (TCE) leve es imprescindible adecuar la indicación de pruebas radiológicas. La regla de predicción clínica PECARN es la más utilizada para ayudar en la toma de decisiones clínicas. Objetivos: Evaluar la variabilidad en la realización de pruebas radiológicas en los menores de 3 meses con un TCE leve en los servicios de urgencias pediátricos y la adherencia de cada hospital a las recomendaciones de la regla de predicción clínica PECARN. Población y métodos: Estudio de cohortes prospectivo en<3 meses con un TCE leve que consultaron en 13 servicios de urgencias pediátricos españoles entre mayo de 2017 y noviembre de 2020. Resultados: Se atendieron 21.981 pacientes con un TCE leve, de los que 366 (1,7%) eran menores de 3 meses. Se realizaron pruebas de imagen al 53,3% (195): TC craneal a 37 (10,1% [rango entre hospitales 0-40%]), radiografía de cráneo a 162 (44,3% [rango 0-100%]) y ecografía transfontanelar a 22 (6,0% [rango 0-24%]). Se siguieron las recomendaciones PECARN en el 25,6% (10/39) de los lactantes con criterios de alto riesgo (rango 0-100%); el 37,1% (36/97) de los de riesgo intermedio (rango 0-100%) y el 57,4% (132/230) de los de bajo riesgo (rango 0-100%). Conclusiones: Existe gran variabilidad, con un bajo cumplimiento de las recomendaciones PECARN, en la realización de pruebas radiológicas en los menores de 3 meses que consultan por un TCE leve en los servicios de urgencias pediátricos españoles, a expensas fundamentalmente de un exceso en el empleo de radiografías de cráneo. (AU)
Introduction: In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. Objectives: To analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments and the adherence of each hospital to the recommendations of the PECARN rule. Population and methods: We conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020. Results: Of 21,981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%40.0%), skull X-rays in 162 (44.3%; range, 0%100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%100%); 37.1% (36/97) classified as intermediate-risk (range, 0%100%) and 57.4% (132/230) classified as low-risk (range, 0%100%). Conclusion: We found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish paediatric emergency departments s, mainly due to an excessive use of skull X-rays. (AU)