Acute Poisoning in Children; Data of a Pediatric Emergency Unit

Objective

Acute Poisoning in children is still an important public health problem and represents a frequent cause of admission in emergency units. The epidemiological surveillance specific for each country is necessary to determine the extent and characteristics of the problem, according to which related preventive measures can be taken.

Methods

The present retrospective study describes the epidemiology of accidental and suicidal poisonings in a pediatric population admitted to the Pediatric Emergency Department of Eskisehir Osmangazi University Hospital during the year 2009.

Findings

Two hundred eighteen children were reffered to the emergency department due to acute poisoning. 48.4% of patients were boys and 51.6% were girls. The majority of cases were due to accidental poisoning (73.3% of all patients). Drugs were the most common agent causing the poisoning (48.3%), followed by ingestion of corrosive substance (23.1%) and carbon monoxide (CO) intoxication (12.5%). Tricyclic antidepressant was the most common drug (11.7%). Methylphenidate poisoning, the second common drug. 262 patients were discharged from hospital within 48 hours.

Conclusion

Preventable accidental poisonings are still a significant cause of morbidity among children in developing countries. Drugs and corrosive agents are the most frequent agents causing poisoning.     

Pediatric Emergency Medicine Fellows Education Day: Addressing CanMEDS objectives at a national subspecialty conference

Canadian subspecialty residency training programs are developed around the learning objectives listed in the seven Canadian Medical Education Directives for Specialists (CanMEDS) criteria. Delivering content on objectives outside of those traditionally acquired in clinical rotations can be a challenge. In the present article, the planning process, curriculum development, and evaluation and assessment of a national subspecialty conference model in providing CanMEDS objective-based content sessions in the categories other than Medical Expert (Professional, Scholar, Communicator, Collaborator, Manager and Health Advocate) is described. It is hypothesized that the development of a CanMEDS objective-based curriculum would be positively received by subspecialty residents attending this conference. Attendees of sessions in a two-year curriculum cycle assessed the content as valuable, relevant and effective. The application of this process can be useful to other subspecialty residency training programs to meet the needs of their CanMEDS objective-based training requirements.     

Emergency treatment of anaphylaxis in infants and children

Anaphylaxis is a severe, acute and potentially life-threatening condition, often in response to an allergen. Patients experiencing anaphylaxis can present with cutaneous, respiratory, cardiovascular or gastrointestinal manifestations. Epinephrine given intramuscularly remains the mainstay of treatment for this condition. Other second-line therapies, such as inhaled beta-2 agonists, H1 and H2 receptor antagonists and corticosteroids, may play a role in resolving respiratory and cutaneous signs and symptoms. Biphasic reactions may occur during the resolution phase of symptoms and, thus, all patients should be observed for a minimum of 4 h to 6 h before discharge from hospital. On discharge, all patients should be prescribed epinephrine autoinjectors, and referred to an allergist or immunologist for further evaluation and education.     

Emergency department use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children

Acute gastroenteritis is one of the most common causes of emergency room visits. Although it is usually a self-limited infection, vomiting related to this illness can cause various degrees of dehydration, leading to intravenous insertion, electrolyte abnormalities and/or hospital admission. Ondansetron is a highly potent antiemetic drug that is effective in preventing chemotherapy-and radiation-induced nausea and vomiting with a very low risk of adverse effects. Recently, ondansetron has been used to control vomiting related to acute gastroenteritis. The present article examines evidence for the use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children, and provides a recommendation for treatment based on the evidence-based review.     

2009至2010年西安市儿童医院急诊患儿死亡原因分析

目的 了解近2年西安市儿童医院急诊患者死亡疾病谱变化和直接死亡原因.方法 对2009年至2010年我院收治的130例急诊死亡病例进行回顾性分析.结果 2009年主要死亡疾病依次为:肺炎,先天性心脏病,窒息,新生儿肺出血,颅内出血;2010年主要死亡疾病依次为:肺炎,窒息,病毒性脑炎,先天性心脏病,新生儿肺出血,两年死亡疾病谱发生了明显变化.91例患儿找到直接死亡原因,依次为:呼吸衰竭25例(27.5％),心力衰竭17例(18.7％),休克17例(18.7％),窒息16例(17.5),脑疝16例(17.5％).结论 要降低急诊患儿的病死率,必须加强婴幼儿卫生保健,积极治疗肺部感染和全身感染,积极抗休克治疗,控制心力衰竭,以及预防误吸.     

Profile of childhood poisoning at a tertiary care centre in North India

Objectives  To determine the profile and outcome (discharge from emergency room after observation, admission or death) of pediatric patients presenting with acute poisoning to a tertiary care centre in north India. Methods  We retrospectively reviewed the last 2 year (July, 2004 to July, 2006) hospital records of pediatric emergency room to profile all cases of pediatric poisoning during that period and noted their outcome. All cases age ≤ 12 years with definite history of poisoning were included. Results  111 patients presented to the pediatric emergency during the study period. Mean age of our patients was 3.12 ± 2.04 yrs (SD). Majority of our patients (63.9%) was in the 1–3 yr age group. Males outnumbered females by a factor of two; majority of our patients resided in urban areas. Kerosene (27.9%), drugs (19.8%) and insecticides (11.7%) were the agents most frequently implicated. Almost all (96.9%) ingestions were accidental in nature. Thirty six patients (32.4%) were asymptomatic after 6 hr of observation in the emergency ward; 75 patients (67.6%) developed symptoms related to toxic ingestion. The common serious symptoms included altered sensorium, respiratory distress, seizures, ataxia, hypotension, cyanosis and burns; three patients required intubation and mechanical ventilation. Almost one third of our patients underwent gastric lavage; no patient with kerosene poisoning or any other inappropriate indication underwent the same. Conclusion  The trends for pediatric poisoning noted at our centre are not very different from those observed in hospital-based studies conducted more than a decade ago, despite the rapid socioeconomic development in our country. In sharp contrast to developing countries, where majority of poisonings are due to common non-toxic household products, most of our patients require hospitalization because of severe symptoms related to dangerous nature of toxins ingested. Consultation with the poison cell results in improved patient management.     

利用CONSORT声明评价2011至2015年《中国小儿急救医学》杂志临床试验研究报告质量

目的 利用CONSORT声明统计和评价《中国小儿急救医学》杂志上临床试验研究报告的质量.方法 检索万方数据库,收集从2011年1月至2015年11月发表在《中国小儿急救医学》杂志的所有文章,利用2010年CONSORT声明,对临床试验类的文章进行评价和分析.结果 在检索出的1317篇文章中,有62篇(4.7％)属于临床试验.参照CONSORT声明,所有文章均满足从1b到6b项标准(包括摘要,引言,方法中的实验设计、受试者、干预及结局报告的各项要求),而满足项目8a(描述产生随机分配顺序的方法)的有30篇(48.4％),满足项目8b(描述随机化的种类及任何限制)的有4篇(6.5％),没有文章满足项目9(描述实施随机分配顺序的方法,在实施干预前隐蔽分配顺序的步骤)和项目10(谁产生的分配顺序,谁登记的参加者,谁将参加者分配到各组中).在这62篇文章中,33篇(53.2％)所关注的结局为呼吸系统相关疾病,而关注结局为神经系统、循环系统和消化系统疾病的文章分别有5篇(8.1％)、4篇(6.5％)和4篇(6.5％).虽然62篇文章均提示结果有统计学意义,但只有38篇(61.3％)文章提及随机分组、7篇(11.3％)文章提及随访、5篇(8.1％)文章提及盲法,而在文中画出流程图的只有1篇(1.6％).结论 国内临床医生在《中国小儿急救医学》杂志上发表的临床试验报告并没有完全参照CONSORT声明.     

Prolonged follow up of seven patients affected by hepatosplenic granulomata due to cat-scratch disease

This study is a retrospective analysis of seven patients with hypoechogenic lesions in the liver and/or spleen due to Bartonella henselae, who were followed from 1998 through to 2005 by the Department of Pediatrics, Turin University. In addition to showing constitutional symptoms, four children had skin lesions suggestive of injuries inflicted by cats, and one child had a history of exposure to cats. The origin of the infection remained undefined in the other two patients. Humoral tests enabled a precise diagnosis in all children. Treatment with macrolides or combinations of two active antibiotics for at least 2–3 weeks led to the definitive clearance of infection, although residual intraparenchymal lesions persisted in five patients for several months or years. Conclusion B. henselae serology allows an easy diagnosis of multiple hepatosplenic granulomata, a clinical picture that appears to be under-recognized. Macrolides or a combination of two active antibiotics for 2–3 weeks leads to a rapid clinical response and a definitive clearance of infection.     

Development,Implementation, and Evaluation of the Apollo Model of Pediatric Rehabilitation Service Delivery

ABSTRACT

This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to improve the quality of services provided to children with disabilities, their families, and their communities.     

我国儿童急救体系建设现状与发展思考

通过分析儿童急危重症院前急救、急诊及重症医学科、急救护理、急救培训和急救科研现状,阐述我国儿童急救体系建设存在的问题,提出发展思路和建设建议.     

Pediatric chronic patients at outpatient clinics: a study in a Latin American University Hospital

Objective

To describe the characteristics of children and adolescentes with chronic diseases of outpatient clinics at a tertiary university hospital.

Caregiver Low Health Literacy and Nonurgent Use of the Pediatric Emergency Department for Febrile Illness

ObjectiveTo examine the association between caregiver health literacy and the likelihood of a nonurgent emergency department (ED) visit in children presenting for fever.MethodsThis cross-sectional study used the Newest Vital Sign to assess the health literacy of caregivers accompanying children with fever to the ED. Visit urgency was determined by resources utilized during the ED visit. Findings were stratified by race and child age. Chi-square and logistic regression analysis controlling for race were conducted to determine the association between low health literacy and ED visit urgency.ResultsA total of 299 caregivers completed study materials. Thirty-nine percent of ED visits for fever were nonurgent, and 63% of caregivers had low health literacy. Low health literacy was associated with a higher proportion of nonurgent ED visits for fever (44% vs 31%, odds ratio 1.8, 95% confidence interval [CI] 1.1, 2.9). Low health literacy was associated with higher odds of a nonurgent visit in white and Hispanic caregivers but not in black caregivers. In regression analysis, children ≥2 years old had higher odds of a nonurgent visit if caregivers had low health literacy (adjusted odds ratio 2.0; 95% CI 1.1, 4.1); this relationship did not hold for children <2 years old (adjusted odds ratio 0.8; 95% CI 0.4, 1.8).ConclusionsNearly two-thirds of caregivers with their child in the ED for fever have low health literacy. Caregiver low health literacy is associated with nonurgent ED utilization for fever in children over 2 years of age. Future interventions could target health literacy skills regarding fever in caregivers of children ≥2 years.