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Objective Streptococcal toxic shock syndrome (STSS) is a very rare and severe entity from among the invasive diseases caused by Streptococcus pyogenes, whose characteristics, treatment, morbidity, and mortality are little known in pediatrics. The aim of this study was to determine its prevalence and the characteristics of its presentation in the emergency department (ED) in Spain. Methods This is a descriptive and observational study. Patients from 1 month to 18 years of age, admitted to the ED with a final diagnosis of STSS between 2009 and 2014, were included. Patients whose parents or guardians did not allow informed consent were excluded. Results Nine cases were diagnosed (1/100,000 consultations); the median average age was 2 years, and five were girls. No patient had a significant medical history. The most frequent reason for consultation was fever (9/9), followed by respiratory symptoms (6/9). Six presented in the ED with shock. Seven were diagnosed with pleuropneumonia, one with meningitis, and one with necrotizing fasciitis. All patients required admission at the pediatric intensive care unit, mechanical ventilation, and inotropic support. All had a complete recovery. Conclusion STSS is a rare entity in the ED affecting healthy patients who presented respiratory or otorhinolaryngology disease. In our patients, nonspecific clinical manifestations and its rapid progression to shock are shown, meaning the importance of bearing this entity in mind in the emergency room. Understanding the epidemiology and clinical manifestations of this syndrome in our work area helps pediatricians to recognize it and to initiate the appropriate treatment at an early stage, which helps engender a quick and effective approach, essential for a favorable prognosis.

Introduction: Several authors question the performance of systematic renal ultrasound after first urinary tract infection (UTI) in young children, given the high sensitivity of prenatal ultrasounds to detect major malformations and the low prevalence of clinical relevant findings. The aims of this study are to evaluate the yield of renal ultrasound performed after the first UTI in patients aged less than 2 years and to analyse potential risk factors (RF) of altered renal ultrasound. Patients and methods: Retrospective study, including patients aged less than 2 years diagnosed with UTI in the Emergency Department between July 2013 and December 2014. Patients with an underlying nephro-urological pathology, previous UTIs and those without prenatal or post-infection renal ultrasound were excluded. Altered renal ultrasound was defined as the presence of dilated urinary tract or structural abnormalities. Potential RF analysed were: male, age less than 3 months, presence of fever and microorganism other than Escherichia coli. Univariate and multivariate logistic regression were performed. Results: A total of 306 patients were included. Altered renal ultrasound was found in 35 cases (11.4%; 95% CI 8.3–15.5): 24 (68.6%) urinary tract dilation, and 11 (31%) structural abnormalities. Among the cases with altered ultrasound, 68.6% were male, 51.4% were younger than 3 months, 74.3% were febrile, and 31.4% were caused by microorganisms other than E. coli, compared to 45% (P = .009), 31.7% (P = .021), 78.2% (P = .597) and 10% (P = .001) of cases with normal ultrasound. In the multivariate analysis, age less than 3 months (OR 2.1; 95% CI 1.0–4.3, P = .05) and microorganism other than E. coli (OR 3.8; 95% CI 1.7–8.7, P = .002) remained as RF. Conclusions: The yield of renal ultrasound after the first UTI is low. Its indication should be individualised according to the presence of RF: age less than 3 months and microorganism other than E. coli. Resumen: Introducción: Diversos autores cuestionan la realización sistemática de una ecografía renal en los lactantes con una primera infección del tracto urinario (ITU), dada la alta sensibilidad de las ecografías prenatales para la detección de malformaciones mayores y la baja prevalencia de hallazgos clínicamente significativos. Los objetivos de este trabajo son valorar el rendimiento diagnóstico de la ecografía renal realizada después de la primera ITU en pacientes menores de 2 años y analizar posibles factores de riesgo (FR) de presentar una ecografía renal alterada. Pacientes y métodos: Estudio retrospectivo. Se incluyen los pacientes menores de 2 años diagnosticados de ITU en Urgencias entre julio de 2013 y diciembre de 2014. Se excluyen aquellos con enfermedad nefrourológica, ITU previas y sin ecografía renal prenatal o postinfección. Se considera ecografía renal alterada la presencia de dilatación de las vías urinarias y/o anomalías estructurales. Los posibles FR evaluados son: sexo masculino, edad inferior a 3 meses, fiebre y microorganismo distinto a Escherichia coli. Se realiza estudio univariante y por regresión logística multivariante. Resultados: Se incluyen 306 pacientes. Presentan ecografía renal alterada 35 (11,4%; IC 95% 8,3-15,5): 24 (68,6%) dilatación de las vías urinarias y 11 (31%) alteraciones estructurales. De las ecografías alteradas, el 68,6% corresponden a varones, el 51,4% a una edad inferior a 3 meses, el 74,3% a ITU febriles y el 31,4% por microorganismo distinto a E. coli, respecto al 45% (p = 0,009), el 31,7% (p = 0,021), el 78,2% (p = 0,597) y el 10% (p = 0,001) de las ecografías normales. En el análisis multivariante se mantienen como FR la edad inferior a 3 meses (OR 2,1; IC 95% 1,0-4,3; p = 0,05) y un microorganismo distinto a E. coli (OR 3,8; IC 95% 1,7-8,7; p = 0,002). Conclusiones: El rendimiento de la ecografía renal después de la primera ITU es bajo. Se debería individualizar su indicación según la presencia de FR: edad inferior a 3 meses y microorganismo distinto a E. coli.

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 h 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. Resumen: 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 and objective In the last years, an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyse the epidemiology and the clinical features of ID due to SGA in a tertiary paediatric hospital. Material and methods This was a retrospective study of all in-patients with final diagnosis of ID due to SGA during 6 years (2009–2014) in a paediatric hospital. To consider ID, SGA had to be isolated in sterile samples, in patients with fasciitis necroticans in skin samples or in any sample in patients with the diagnosis of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of the following criteria: renal failure, hepatic failure, acute respiratory distress, tissue necrosis or desquamative erythematous rash. Demographic data, type of infection, risk factors, clinical presentation, analytical data at admission, treatment, need for admission to a pediatric intensive care unit, microbiological data, hospital stay and evolution were collected. Results Fifty-two (52) cases were included (12/10,000 of all inpatients); 3 years old was the medium age (p25-75: 1.4–6.9 years) and 28 (53.8%) were boys. Fourteen patients (26.9%) had risk factors. Fever was the major symptom (51 patients, 98.1%). The skin lesions were the most frequent clinical manifestations found (21; 40.4%). In 50 (96%) cases, SGA was isolated in at least one sterile sample. Skin and soft tissue infections were diagnosed in 14 patients (26.9%), 14 (26.9%) pneumonias, 12 (23.1%) bones and joints infections, 10 (19.2%) SSTS, 6 (11.5%) occult bacteremia, 4 (7.7%) meningitis and 2 (3.8%) sepsis. Surgery was required in 18 cases (34.6%) and 17 patients (32.7%) needed intensive care. The medium hospital stay was 9.5 days (p25-75: 8–15 days). Three patients presented sequels and one patient died. Conclusion The ID due to SGA was a rare but serious reason for hospital admission. Skin and soft tissue infections and pleuroneumonia were the most common forms of ID. The mortality of our sample was low despite the serious clinical manifestations.

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. Resumen: 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.

Objective: The protocol for the management of mild cranioencephalic trauma in the emergency department was changed in July 2013. The principal innovation was the replacement of systematic skull X-ray in infants with clinical observation. The aims of this study were to determine whether there was (1) a reduction in the ability to detect traumatic brain injury (TBI) in the initial visit to Emergency, and (2) a change in the number of requests for imaging tests and hospital admissions. Methodology: This was a retrospective, descriptive, observational study. Two periods were established for the study: Period 1 (1/11/2011–30/10/2012), prior to the implementing of the new protocol, and Period 2 (1/11/2013–30/10/2014), following its implementation. The study included visits to the emergency department by children ≤2 years old for mild cranioencephalic trauma (Glasgow Scale modified for infants ≥14) of ≤24 h onset. Results: A total of 1,543 cases were included, of which 807 were from Period 1 and 736 from Period 2. No significant differences were observed as regards sex, age, mechanism, or risk of TBI. More cranial fractures were detected in Period 1 than in Period 2 (4.3% vs 0.5%; P

Objectives: The aim of this study is to evaluate the effectiveness of a disaster preparedness training programme in a Paediatric Emergency Department (PED). Methods: A quasi-experimental study was conducted using an anonymous questionnaire that was distributed to health care providers of a PED in a tertiary paediatric hospital. The questions concerned the disaster plan (DP), including theoretical and practical aspects. Questionnaires were distributed and completed in January 2014 (period 1) and November 2014 (period 2). The disaster training programme includes theoretical and practical sessions. Results: A total of 110 questionnaires were collected in period 1, and 80 in period 2. Almost three-quarters (71.3%) of PED staff attended the theoretical sessions, and 43.8% attended the practical sessions. The application of this training programme significantly improved knowledge about the DP, but no improvement was observed in the practical questions. PED staff felt more prepared to face a disaster after the training programme (15.5% vs. 41.8%, P

Resumen: 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. Abstract: 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.

Introduction: It is well known that some symptoms in children with ventriculoperitoneal shunt are associated with a higher risk of developing shunt malfunction. However none of those symptoms are sensitive or specific enough to diagnose the shunt malfunction. Objective: To develop a diagnostic scale to identify children with an increased risk of shunt malfunction in the Emergency Department. Material and methods: This is a prospective study including children aged one to eighteen years old admitted to the Emergency Department between April 2010 and March 2013 with symptoms of ventriculoperitoneal shunt malfunction. Logistic regression Analysis was used to determine whether or not the variables were considered independent risk factors for shunt malfunction. The results led to the development of a diagnostic scale. Results: A scale was developed using 9 variables (erythema, swelling or discharge from the catheter trajectory, drowsiness, stiff neck, headache, afebrile, age >4 years, vomiting, recent neurological deficit, and time since last surgery ≤2 years) with a maximum score of 20 points. It was found that Scale scores ≥7 points were associated with an increased risk of shunt malfunction (OR 34.0, 95% CI 15.4–74.9; sensitivity 88.3%, specificity 81.1%, PPV 53.4%, NPV 96.7%). Discussion: A diagnostic scale is designed for assessing the risk of shunt malfunction, selecting those patients with a higher risk. The use of this scale could help the management of these patients, reducing complementary tests, as well as the usual radiation suffered by these children. Resumen: Introducción: Es conocido que la presencia de determinadas manifestaciones clínicas en los niños portadores de una válvula ventrículo-peritoneal (VDVP) se asocia a un mayor riesgo de disfunción valvular (DV), sin embargo, ninguna de estas es suficientemente sensible y específica por sí sola para diferenciar los pacientes que presentan una DV de los que no, y permitir así una actuación diagnóstica y terapéutica más adecuada. Objetivo: Elaborar una escala diagnóstica que permita seleccionar en el Servicio de Urgencias a los niños con riesgo de DV. Material y métodos: Estudio prospectivo. Se incluyó a los pacientes portadores de VDVP con edad comprendida entre 1 y 18 años que consultaron con sintomatología potencialmente asociada a DV en un Servicio de Urgencias durante 3 años (1 de abril del 2010-31 de marzo del 2013). Mediante regresión logística se determina qué variables se consideran factores de riesgo independientes de DV; con ellos se elabora una escala diagnóstica. Resultados: Se obtiene una escala basada en 9 variables (eritema, tumefacción o secreción en el trayecto del catéter; somnolencia; rigidez de nuca; cefalea; ausencia de fiebre; edad mayor a 4 años; vómitos; focalidad neurológica reciente y tiempo desde la última intervención quirúrgica menor o igual a 2 años) con una puntuación máxima de 20 puntos. Puntuaciones de la escala de 7 o más puntos se asocian a un mayor riesgo de DV (OR 34,0; IC del 95%, 15,4-74,9; sensibilidad 88,3%; especificidad 81,1%; VPP 53,4%; VPN 96,7%). Discusión: La escala diagnóstica para la valoración del riesgo de DV presentada permite seleccionar los pacientes con riesgo de DV. Su uso podría ayudar a mejorar la indicación de las pruebas complementarias que reciben los niños portadores de una VDVP y disminuir la irradiación a la que son sometidos estos pacientes.

a b s t r a c t Background: Infants less than 3 months of age with urinary tract infection are usually hospitalized. Recent studies show that a less aggressive management for those patients aged ≥ 29 days may be feasible. Objectives: To determine the complication rate in infants < 3 months of age with urinary tract infection, and to identify the causative agents and their antibiotic susceptibility. Methods: A retrospective study was conducted on infants < 3 months of age with positive urinalysis results, together with a positive urine culture from a catheterized specimen and seen in the Emergency Department from 2007 to 2012. Demographics, clinical and microbiology (microorganism isolated and

Resumen Introduccion La mayoria de publicaciones actuales sobre el manejo del traumatismo craneoencefalico (TCE) leve ya no tienen en cuenta la presencia de una fractura craneal para determinar el riesgo del lesion intracraneal (LIC). Sin embargo, en nuestro medio sigue siendo habitual la realizacion de radiografias de craneo en los ninos pequenos para descartar su presencia. Objetivo Determinar la prevalencia de LIC clinicamente importante (LICCI) en los ninos menores de 2 anos con TCE leve atendidos en urgencias. Pacientes y metodos Revision retrospectiva de los informes de urgencias de los ninos menores de 2 anos atendidos por TCE leve (Glasgow ≥ 14 puntos) durante un ano. Se define LICCI aquella LIC que tiene como consecuencia la muerte, una intervencion neuroquirurgica, ventilacion mecanica o soporte inotropico. Resultados Se incluyen 854 ninos, con una mediana de edad de 11,0 meses (P 25-75 : 7,5-17,0 meses). Cuatrocientos cincuenta y siete (53,5%) eran varones. En 741 casos (86,8%) el mecanismo del TCE fue una caida. En 438 (51,3%) se realizo una radiografia craneal. En 11 casos (1,3%) se diagnostico una LIC, ninguna clinicamente importante (prevalencia de LICCI en ninos menores de 2 anos con TCE leve: 0%; IC 95% 0-0,4%). Conclusiones Los ninos menores de 2 anos con TCE leve tienen un riesgo muy bajo de LICCI. La observacion clinica puede considerarse como una alternativa valida a la realizacion de radiografias de craneo.

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

Introduction: Improving patient experience must become a priority in paediatric emergency departments. This experience is often studied by surveying parents, and not children directly. The aim of this study was to assess the patient experience of children attended in a Paediatric Emergency Department (PED). Patients and methods: A prospective descriptive study was conducted using a survey based on the Picker questionnaire on the patient experience. From January to May 2014, children 8–17 years seen in the Paediatric Emergency Department and admitted to the hospital were asked to complete the questionnaires anonymously, within 24 h of admission. Results: A total of 217 patients completed the survey. The responses showed that 19.4% had to wait longer than expected, with 46.2% saying that there was not enough for children of their age group to do while waiting to be seen. As regards care and treatment, 4.6% of participants said staff did not fully explain what they were doing, and 23% said that they were not given enough privacy when being examined. Overall, 99.1% of patients said that they were well treated. Conclusions: Overall patient experience in the PED was positive. Some aspects have to be improved (activities in the waiting room, and privacy during the examination). Resumen: Introducción: Mejorar la experiencia del paciente debe convertirse en una prioridad en los Servicios de Urgencias. En Pediatría, a menudo, se estudia la opinión de padres/cuidadores y no la de los niños directamente. El objetivo de este estudio es conocer la experiencia como paciente del pediátrico ingresado desde el Servicio de Urgencias pediátricas. Pacientes y métodos: Estudio descriptivo prospectivo. Se diseña una encuesta basada en el cuestionario Picker sobre la experiencia del paciente que estudia la proporción de insatisfacción. Las encuestas son contestadas directamente por niños de 8-17 años que son visitados e ingresados desde Urgencias de un hospital terciario pediátrico. Se entregan las encuestas durante las primeras 24 h de ingreso de enero a mayo del 2014. Resultados: Se obtienen 217 encuestas. La mediana edad es de 12 años. Los niños piensan que la espera fue más larga de lo esperado (19,4%) y que las actividades de entretenimiento fueron inadecuadas (46,2%). Sobre la visita médica, el 4,6% piensa que el personal no explicó correctamente los procedimientos y para el 23% no tuvieron la suficiente privacidad. Sobre el conjunto de la visita, el 99,1% de los pacientes se sintió bastante o muy bien tratado. No se han encontrado diferencias en el grado de satisfacción en función del sexo, la edad o el tiempo de espera. Conclusiones: Globalmente, la experiencia del paciente pediátrico en nuestro Servicio de Urgencias fue positiva. Algunos aspectos son susceptibles de mejora, como las actividades durante la espera y la privacidad durante la visita.

Resumen Fundamento y objetivos Describir la consultas relacionadas con el consumo de sustancias psicoactivas (SP) generadas por adolescentes en un servicio de urgencias (SU) y valorar posibles caracteristicas diferenciales en el perfil de los pacientes en funcion de la SP consumida. Pacientes y metodo Estudio analitico y observacional. Se incluyeron durante 30 meses las consultas de adolescentes a un SU relacionadas con consumo de SP; se compararon las intoxicaciones etilicas aisladas (grupo 1) con las de otras SP (grupo 2). Resultados Se incluyeron 333 consultas de 321 pacientes. Su edad media fue 16,1 anos (DE: 1,1). Doscientos sesenta y dos pacientes (78,7%) habian consumido alcohol y 110 (33%) habian consumido otras SP. En total, en el grupo 1 se incluyeron 223 consultas y en el grupo 2 se incluyeron 110 consultas. En el grupo 2 se detecto mayor proporcion de varones, mas residentes en centros de menores y mas adolescentes con antecedentes psiquiatricos que en el grupo 1. Asimismo, la distribucion de las consultas del grupo 2 fue menos previsible que la del grupo 1. Conclusiones Las SP generan frecuentemente consultas en el SU. Parece que los adolescentes con problemas psicosociales consumen mas SP diferentes del alcohol y sus consultas son menos predecibles en el tiempo.

The objective of this study is to assess the impact of various actions in the management of pain in a pediatric hospital emergency department. This is an observational study, preaction (phase 1) and postaction (phase 2), with two cohorts of patients diagnosed with abdominal pain, chest pain, and severe headache. Between the two phases, various actions were carried out (distribution of pain assessment scales and a new guide for the management of pain, and the holding of clinical training sessions). Three hundred patients were included in the study, with an average age of 9 years and average evolution time of pain of 20 h. Pain assessment in phases 1 and 2 was 30 and 99.3%, respectively. Analgesics were administered to 23% (phase 1) and 38.6% (phase 2) of the patients with pain. No side-effects from the analgesics given were recorded. In conclusion, the various actions carried out yielded an improvement in pain management, especially in its assessment.

OBJECTIVE: : To report a case of unexpected shaken baby syndrome, the diagnosis of which was possible after an incidental funduscopic examination. METHODS: : Observational case report. An infant was to be sent back home with an apparent unprovoked seizure diagnosis when a funduscopic examination was made because of an incidental research study changing the diagnostic orientation. RESULTS: : Extensive bilateral subretinal hemorrhages in the funduscopic examination allowed shaken baby syndrome unexpected diagnosis. A funduscopic examination is not usually included in the first seizure diagnosis management, even when a retinal bleeding could be present and be the clue for its causative diagnosis. CONCLUSION: : We recommend having in mind the practice of a funduscopic examination in all children with a first apparently unprovoked seizure. Language: en