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Objectives Osteoarticular infections are infrequent in pediatric patients, although their incidence seems to be increasing. They usually affect children younger than 5 years and tend to localize in the lower limbs. Because of their nonspecific symptoms, especially at onset, a timely diagnosis is difficult to achieve, with the subsequent risk of a delay in treatment. We hereby report the management of osteoarticular infections in our pediatric emergency department. Methods This is a retrospective descriptive study of patients diagnosed with osteoarticular upper limb infection in the pediatric emergency department of a tertiary hospital from January 2011 to December 2016. Results From an initial global sample of 170 patients diagnosed with osteomyelitis or septic arthritis at any location at the pediatric emergency department, 32 children (18.82%) with upper limb involvement were included in the study. Of them, 22 were male and the mean age at diagnosis was 14.5 months (interquartile range, 2-106). Eighteen patients (56%) were diagnosed with septic arthritis, and 14 (44%) had a diagnosis of osteomyelitis.The most frequent symptom was pain (50%). More than one third of patients (11) had received a different diagnosis in a previous hospital visit. A traumatic etiology was suspected in 7 cases (21%).Regarding acute phase reactants, the mean value for C-reactive protein was 21.3 mg/L, and erythrocyte sedimentation rate was elevated in 27 cases (84%). In 28 patients, blood cultures were obtained, 24 of which came back negative. All children received antibiotic treatment and achieved a full recovery. Conclusions One third of patients were misdiagnosed at the first consultation, which stresses the importance of a high clinical suspicion to avoid delays in diagnosis and treatment of osteoarticular infections. This study also shows a lower mean age of children with upper limb infection as compared with those with lower limb infection. All patients recovered fully with oral antibiotics.

Limited paediatric data on COVID-19 suggest that it is less frequent and severe in children than in adults.1 2 Spain is currently one of the most affected countries. Our aim was to describe the patients under the age of 18 years diagnosed with SARS-CoV-2 infection at Hospital La Paz (Madrid) in the first month of the outbreak (11 March to 9 April 2020). Inclusion criteria were all children who underwent PCR for SARS-CoV-2 in nasopharyngeal smears. Out of 349 children, 58 (16.6%) had a positive PCR for SARS-CoV-2 (table 1). All had compatible symptoms, except two cases in which the PCR was indicated prior to intensive care unit (ICU) admission or surgery. Twenty-five (43%) children were followed up as outpatients. Nine of them (35%) attended a second time but none required hospital …