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Background and Objectives: Fever is a frequent cause of consultation in the pediatric emergency department (PED). Adequate discharge instructions are essential to guarantee good management at home and can reduce caregivers' anxiety and re-consultations. This study compares the improvement of caregivers' knowledge regarding fever between verbal discharge instructions and the addition of a video to verbal information. As a secondary outcome, we compared the rate of return visits., Methods: An experimental, prospective, single-center study was conducted in a tertiary hospital PED. Patients between 3 months and 5 years old with febrile syndrome were enrolled. Patients with comorbidities or SARS-COV2 infection were excluded. First, caregivers answered a written test concerning fever characteristics, management, and warning signs. Patients were assigned by simple randomization to a control group (standard verbal and written instructions) or to an intervention group (which additionally received video instructions). After discharge, investigators contacted caregivers by telephone. Caregivers were asked to answer the same questions as in the written test in addition to the need for subsequent visits (at the PED or any other healthcare facility) after discharge., Results: Seventy-three patients were randomized to the intervention group and 77 to the control group (2 were lost during follow-up). There were no differences in the acquisition of caregiver's knowledge, with a median score improvement of 2 points in both groups (control group interquartile range (IQR) 1-2; intervention group IQR 1-3) (P = .389). In the intervention group, we observed a significant increase of correct answers in 4 out of 7 questions compared to 3 out of 7 questions in the control group. In the control group, 18.7% reconsulted compared to 10.9% in the intervention group (P = .188)., Conclusions: Video instructions were not superior to verbal instructions at improving caregivers' knowledge of fever overall. However, more questions obtained a significant score increase in those that received video and verbal instructions. Our results suggest that the addition of video instructions could help reduce return visits., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background and Objectives: In the 2023-2024 respiratory syncytial virus (RSV) season, Spain became one of the first countries to introduce universal RSV prophylaxis, during which all infants born at this time were eligible to receive nirsevimab. Locally, most Spanish regions also immunized infants younger than age 6 months at the start of the season (extended catch-up). The aim of this study was to assess how RSV prophylaxis affected the number of infants presenting to pediatric emergency departments with acute respiratory infections., Methods: A retrospective study was conducted in 15 Spanish pediatric emergency departments from 9 different regions between the 2018 and 2024 epidemic seasons (November-January). We compared the seasons occurring in 2018-2023 and the 2023-2024 season regarding the number of episodes of lower respiratory tract infection and acute bronchiolitis, acute bronchiolitis-related hospital admissions, and PICU admissions., Results: A comparison with the average rates for the previous epidemic seasons revealed a 57.7% decrease in episodes of lower respiratory tract infection in 2023-2024 (95% CI, 56.5-58.8; P < .001; range among hospitals, 4.8-82.8), a 59.2% decrease in episodes of acute bronchiolitis (95% CI, 57.9-60.4; P < .001; range, 6.9-84.1), a 63.1% reduction in acute bronchiolitis-related hospital admissions (95% CI, 60.9-65.2; P < .001; range, 31.4-86.8), and a 63.1% reduction in PICU admissions (95% CI, 58.1-67.9; P < .001; range, 18.2-81.8). Hospitals in regions applying extended catch-up showed better results., Conclusions: Nirsevimab can protect a broad infant population against RSV infection with high effectiveness. Approaches including extended catch-up are the most effective, although cost- effectiveness must be considered., (Copyright © 2024 by the American Academy of Pediatrics.)

The lockdown during the SARS-CoV-2 pandemic and the effect of the virus on the population could be a precipitating factor for mental health disorders in the pediatric population., Objective: To compare the reasons for consultation, diagnoses at discharge, and admission and re-consultation rates of pediatric patients attending the Emergency Department due to mental health disorders before and after the SARS-CoV-2 pandemic lockdown., Patients and Method: Retrospective, descriptive study. Patients under 16 years of age consulting due to mental health-related disorders during the pre- (07/01/2018-07/01/2019) and post-lockdown (07/01/2020-07/01/2021) periods were included. The frequency of mental health diagnoses, need for drug administration, hospitalization, and reconsultations were compared., Results: 760 patients were included, 399 pre-lockdown and 361 postlockdown. After the lockdown, there was a 45.7% increase in the frequency of mental health-related consultations with respect to the total number of emergency consultations. Behavioral alterations were the most frequent reason for consultation in both groups (34.3% vs. 36.6%, p = 0.54). In the post-lockdown period, consultations related to self-harm attempts (16.3% vs. 24.4%, p < 0.01) and the diagnosis of depression (7.5% vs. 18.5%, p < 0.01) increased significantly. There was an increase of 58.8% in patients who were hospitalized with respect to the total number of ED patients (0.17% vs. 0.27%, p = 0.003) and in the number of re-consultations (12% vs. 17.8%, p = 0.026). No differences were observed in days of hospitalization (7 days [IQR 4-13] vs. 9 days [IQR 9-14], p0.45)., Conclusion: In the post-lockdown period, the proportion of pediatric patients presenting to the ED with mental health disturbances increased.

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., (Copyright © 2022 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The aim of our study was to describe the prevalence of burnout syndrome (BOS) in paediatricians working in paediatric emergency care settings and to analyse its association with potential risk factors., Material and Methods: Multicentre cross-sectional study through a survey of paediatricians working in paediatric emergency care settings in hospitals affiliated to the Research Network of the Spanish Society of Paediatric Emergency Medicine (SEUP) between September 2019 and January 2020. We analysed the association between social/family-related, demographic, occupational and satisfaction factors and the presence of BOS by means of multivariate and multilevel mixed-effects logistic regression models., Results: The estimated prevalence of BOS was 36.5% (95% confidence interval [CI], 31.7 %-41.2%). In the multivariate analysis, lacking a stable group of friends (OR, 2.57; 95% CI, 1.10-5.97), problems in and out of the work setting (OR, 3.06; 95% CI, 1.60-5.88) and a work experience of 9 years or less (OR, 2.31; 95% CI, 1.37-3.90) were identified as individual factors that increased the risk of SBO, while feeling acknowledged by coworkers (OR, 0.48; 95% CI, 0.30-0.79) and acknowledged by one's supervisor (OR, 0.62; 95% CI, 0.41-0.93) were protective factors. In relation to the hospital, the paediatric emergency unit being a subdepartment of the Department of Paediatrics (OR, 3.81; 95% CI, 1.85-7.85), the presence of an on-call emergency medicine specialist around the clock (OR, 3.53; 95% CI,1.62-7.73) and a volume of 28 or more paediatric emergency encounters a day to be managed per on-call physician (OR, 2.05; 95% CI, 1.01-4.16) were identified as independent risk factors for SBO. There was no variability in the prevalence of BOS attributable to differences between hospitals and autonomous communities, save for the described situations., Conclusions: The prevalence of SBO among these providers is high. There are modifiable factors that we can intervene on to address BOS, independently of the hospital or region., (Copyright © 2022 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: To evaluate the impact of a quality-of-care improvement program implemented in emergency departments (EDs) in a Spanish autonomous community with the aim of reducing the use of unrecommended drugs when treating infants for acute bronchiolitis., Material and Methods: Before-after quasi-experimental intervention study. We retrospectively included infants aged 12 months or less who were treated for acute bronchiolitis in 24 Spanish national health system hospital EDs in December during 2 epidemic periods: in 2018, before implementing the program, and in 2019, after implementation. Data collected included epidemiologic information, clinical and care details, and clinical course. The program consisted of providing informative material and training sessions before the epidemic period started., Results: A total of 7717 episodes (4007 in 2018 and 2710 in 2019) were identified. Epidemiologic and clinical characteristics did not differ between the 2 periods. ED use of the following treatments decreased between the 2 periods: salbutamol, from 29.4% (95% CI, 28.8%-30.8%) in 2018 to 10.6% (95% CI, 9.6%-11.6%) in 2019; epinephrine from 6.0% (95% CI, 5.3%-6.8%) to 0.9% (95% CI, 0.7%-1.3%); and hypertonic saline solution fell from 8.2% (95% CI, 7.3%-9.1%) to 2.1% (95% CI, 1.7%-2.6%) (P.001, all comparisons). Prescriptions for salbutamol on discharge fell from 38.7% (95% CI, 36.9%-40.4%) to 10.6% (95% CI, 9.6%-11.6%) (P.001). Admissions and readmissions did not change, and the median time (interquartile range) spent in the ED fell from 81 (44-138) minutes to 66 (37-127) minutes (P.001)., Conclusion: The quality-of-care improvement initiative was able to decrease the number of unrecommended therapeutic interventions for acute bronchiolitis. However, we identified great variations between EDs, suggesting that training and assessment of impact should continue.

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., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The efficacy and safety of the Rapid Intravenous Rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice., Objective: To prepare a document with evidence-based recommendations about RIR in paediatric population., Methods: The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of "relevant outcomes"; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security)., Results: 16 recommendations were set up, from which we can highlight as the main ones: 1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation, moderate evidence). 2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong, high). 3) Isotonic fluids are recommended (strong, high), suggesting saline fluid as the first option (light, low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong, moderate). 4) A rhythm of 20cc/kg/h is recommended (strong, high) during 1-4 h (strong, moderate)., Conclusions: This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting., (Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The efficacy and safety of the rapid intravenous rehydration (RIR) guidelines in children affected by dehydration secondary to acute gastroenteritis is supported by current scientific evidence, but there is also great variability in its use in clinical practice., Objective: To prepare a document with evidence-based recommendations about RIR in paediatric population., Methods: The project was developed based on GRADE methodology, according to the following work schedule: Working Group training; creation of a catalogue of questions about research and definition of «relevant outcomes»; score and selection criteria for each item; bibliographic review; scientific evidence evaluation and synthesis (GRADE); review, discussion and creation of recommendations. 10 clinical questions and 15 relevant outcomes were created (7 about efficacy and 8 about security)., Results: Sixteen recommendations were set up, from which we can highlight as the main ones: (1) RIR is safe for children affected by mild-moderate dehydration secondary to acute gastroenteritis, unless expressly contraindicated or acute severe comorbidity (strong recommendation and moderate evidence). (2) Its use is recommended in this situation when oral rehydration has failed or due to contraindication (strong and high). (3) Isotonic fluids are recommended (strong and high), suggesting saline fluid as the first option (light and low), supplemented by glucose (2.5%) in those patients showing normoglycemia and ketosis (strong and moderate). (4) A rhythm of 20 cc/kg/h is recommended (strong and high) during 1-4 h (strong and moderate)., Conclusions: This document establishes consensus recommendations, based on the available scientific evidence, which could contribute to the standardisation of the use of RIR in our setting., (Copyright © 2021 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: This study assesses the clinical characteristics and epidemiology of children with eye trauma presenting to the Emergency Department in Spain and analyze the risk factors associated with immediate sequelae., Methods: A multicentric prospective case series study conducted during 24 months of patients presenting to the Pediatric Emergency Departments in five hospitals collaborating with the Spanish Pediatric Emergency Research Group. Data were collected from October 2016 through September 2018, including all patients up to the age of 16 years old presenting to the Emergency Department with an ocular trauma. All injuries were classified by Birmingham Eye Trauma Terminology., Results: A total of 242,134 visits to the Emergency Departments took place during the study period, being 1,007 ocular traumas (0.42%; IC 95% 0.40-0.45) and 858 were included in the study. Most commonly, injuries occurred while playing (54.7%), except in the 15 or more-age group, in which sports activities were more common (23.1%). The place of the trauma varied depending on the age group, being home (34.7%) and schools or sports areas (34.3%) the most recurrent. Blunt objects were the most frequent mechanism of trauma (48.6%). Most of the injuries were classified as closed globe (85.5%), mainly contusions (52.7%). Fifty-eight patients (6.8%) presented with immediate sequelae, being the impairment of visual acuity the most common (70.7%). The risk factors associated with immediate sequelae were the 10 or more-age group, the preexisting refractive errors, the open globe injuries and the injuries with blunt objects., Conclusions: Ocular trauma is a frequent chief complaint in the Pediatric Emergency Departments in Spain. Increasing awareness of the serious nature of ocular injuries and the study of the risk factors will help to develop a comprehensive plan for educating both parents and children to minimize preventable eye injuries sequelae., (Copyright © 2020. Publicado por Elsevier España, S.L.U.)