[Demand for paediatric emergency care in a community hospital]

Assessment of the diagnostic utility of the electroencephalogram in pediatric emergencies

INTRODUCTION

We analyze the diagnostic utility of urgent EEG (electroencephalogram) performed in children under 16 years of age in our center.

MATERIAL AND METHODS

Descriptive, retrospective, observational study of consecutive patients from 0 to 16 years of age, who underwent an urgent EEG for any reason, from January to December 2022.

RESULTS

Of the 388 patients, 70 were children: 37 (52.85%) women, and 33 (47.14%) men. Average age: 6.27 ± 4.809. Of the 70 patients, 6 (8.57%) had previous epilepsy. Reasons for consultation: 17 febrile seizures, 10 first focal seizures, 10 first TCG seizures, 6 paroxysmal episodes, 6 absences, 3 myoclonus of extremities, 3 syncope, 2 SE, 2 visual alterations, 2 low level of consciousness, 2 cyanosis, 2 suspected meningitis or encephalitis, 1 choking, 1 atypical headache, 1 chorea, 1 presyncope, 1 language delay. Of the 70 patients, 47 had a normal EEG (67.14%). Of the 47 patients with a normal EEG, 10 were diagnosed with epilepsy, and 3 of them began receiving antiepileptic treatment upon discharge. None of the patients with suspected syncope or paroxysmal disorder (17 patients, 24.28%) had EEG abnormalities. Of the 17 patients with atypical febrile seizures, 3 had EEG abnormalities.

CONCLUSIONS

A third of the EEG records performed in the Emergency Department showed alterations, probably due to the time taken. Almost half of the patients with suspected epilepsy or EE showed EEG abnormalities, which confirmed the diagnosis in these cases and encouraged the clinician to start drug treatment. No case with a high suspicion of epilepsy was dismissed due to the normality of the EEG recording in our series. No patient diagnosed with syncope or paroxysmal disorder had EEG abnormalities. Nearly a quarter of patients with atypical febrile seizures showed EEG abnormalities. We barely register cases of status epilepticus, probably due to the degree of complexity of our center.

[Translated article] Peripheral trauma treated in the paediatric emergency department: Descriptive study

INTRODUCTION

Peripheral trauma is a very frequent cause of consultation in paediatric emergency departments but few studies have been published describing the characteristics of these patients.

MATERIAL AND METHODS

We performed a retrospective descriptive study by reviewing computerised emergency department forms during January and February 2020.

OBJECTIVE

To describe the characteristics of traumatic injuries in our area and to detect possible areas for improvement.

RESULTS

A total of 714 peripheral trauma cases were attended, which represents 9.5% of the total consultations. A total of 52.7% were schoolchildren (6-11 years). The most frequent locations were the ankle (27.5%) and fingers (17.2%). Fracture was detected in 6.7% of cases. Radiographs were requested in 78.6% of the patients, with pathological findings in 9.6% of them. Half of the X-rays were requested due to ankle or finger trauma. Referral to traumatology was made in 16.4% of patients, mainly for elbow and knee trauma, and the most commonly used treatment was general measures (49%) and bandaging (29.4%).

CONCLUSIONS

Peripheral trauma is very common and, in general, banal. A large number of X-rays are requested with a very low yield, so it seems necessary to establish new protocols to reduce the number of requests. Improving training in elbow and knee trauma could improve paediatricians' autonomy in dealing with these more complex injuries.

Peripheral trauma treated in the pediatric emergency department: Descriptive study

INTRODUCTION

Peripheral trauma is a very frequent cause of consultation in paediatric emergency departments but few studies have been published describing the characteristics of these patients.

MATERIAL AND METHODS

We performed a retrospective descriptive study by reviewing computerised emergency department forms during January and February 2020.

OBJECTIVE

To describe the characteristics of traumatic injuries in our area and to detect possible areas for improvement.

RESULTS

A total of 714 peripheral trauma cases were attended, which represents 9.5% of the total consultations. A total of 52.7% were schoolchildren (6-11 years). The most frequent locations were the ankle (27.5%) and fingers (17.2%). Fracture was detected in 6.7% of cases. Radiographs were requested in 78.6% of the patients, with pathological findings in 9.6% of them. Half of the X-rays were requested due to ankle or finger trauma. Referral to traumatology was made in 16.4% of patients, mainly for elbow and knee trauma, and the most commonly used treatment was general measures (49%) and bandaging (29.4%).

CONCLUSIONS

Peripheral trauma is very common and, in general, banal. A large number of X-rays are requested with a very low yield, so it seems necessary to establish new protocols to reduce the number of requests. Improving training in elbow and knee trauma could improve paediatricians' autonomy in dealing with these more complex injuries.

Aplicação da nota de transferência e do Paediatric Early Warning Score no serviço de emergência pediátrica do Hospital de Clínicas de Porto Alegre

Objetivo: avaliar a adesão dos enfermeiros ao preenchimento da Nota de Transferência com emissão do Paediatric Early Warning Score (PEWS) em pacientes pediátricos do Serviço de Emergência.Método: estudo quantitativo, transversal e retrospectivo. O estudo foi realizado a partir da análise de 1.219 prontuários de pacientes de uma unidade de emergência pediátrica, no ano de 2018.Resultados: na avaliação da nota de transferência e PEWS, houve adesão de, respectivamente, 86,8% e 75,2% ao longo do ano. Os motivos de hospitalização variam conforme época do ano. Os pacientes atendidos no Serviço de Emergência foram, majoritariamente, estabilizados no serviço e, somente os pacientes com PEWS alterado, foram encaminhados à unidade de terapia intensiva pediátrica.Conclusões: são necessárias ações de educação com os profissionais, com a finalidade de melhoria dos indicadores relacionados à aplicação do PEWS e da nota de transferência para a garantia de uma assistência segura no que tange à continuidade do cuidado.

Feeling Informed Versus Being Informed: Mixed-Methods Analysis of Family Perceptions and Behavior Following a Pediatric Emergency Department Visit

PURPOSE

To examine perceptions of family-centered care, satisfaction, and quality of communication with health professionals during a pediatric emergency department visit, and to evaluate the perceived usefulness of the information received and whether provider treatment recommendations were followed after discharge.

DESIGN

Embedded mixed methods design with two concurrent phases. Participants in phase 1 were 385 adult relatives of children (age 6 days-17 years, mean 5.0 years, SD 4.5) seen in a pediatric emergency department. On the day of the visit, relatives completed questionnaires exploring perceptions of family-centered care, satisfaction (CSQ-8), and quality of communication with professionals (ad hoc instrument). For phase 2, we conducted daily structured telephone interviews with 37 of these parents over the six consecutive days following the emergency visit.

RESULTS

Satisfaction with the visit was significantly related to the perception of family-centered care (B = 0.25; 95% CI [0.20, 0.29]; p < .001). Follow-up interviews revealed that 45.9% (n = 17) of families did not follow the prescribed treatment and 32.4% (n = 12) made a further appointment with their primary care pediatrician. Qualitative analysis suggested that families lacked certain information from care providers.

CONCLUSIONS

Elements of a family-centered approach were rated positively and families believed that the information they received was useful. Importantly, more than half of the families who were followed up by telephone had doubts about provider treatment recommendations.

PRACTICE IMPLICATIONS

Family-centered care in the pediatric emergency department could enhance communication and help to ensure that treatment recommendations are followed at home.

[Analysis of the healthcare of the paediatric population by General Practitioners in a Continuous Care Point]

OBJECTIVE

The main objective of this study is to analyse the management of paediatric emergencies by Family Doctors in Primary Care. The secondary objective is to determine the appropriateness of hospital referrals.

MATERIAL AND METHODS

A retrospective, observational, and descriptive study was performed. An analysis was carried out on the visits made by children less than 14years-old during one year in continued care opening hours in a basic health area, after single-stage cluster random sampling of 45days.

RESULTS

A total of 447 emergency consultations were made by paediatric patients with a mean age of 6.83years (SD=3.82). Almost all (92.8%) the emergency consultations made by children less than 14years were resolved in situ. The referral rate to hospitals was 7.2% (95%CI: 4.9-10). Just over half (56%: 95%CI: 37.7-73.6) of the children referred had some type of hospital intervention (tests, treatments, assessments by other non-paediatric specialists, observation and or admission).

CONCLUSIONS

The referral rate was 7.2%, which is in the upper limit of that found in other studies. Just over half of the children required some type of intervention, which could be considered as justified referrals. Furthermore, good agreement was found (Kappa index=0.778) between the diagnosis from Primary Care and the final diagnosis by paediatricians, inferring that the diagnosis made on paediatric patients by Family Doctors are correct.

[Paediatric emergency triage in Spanish primary care using mobile phones. Analysis of a model in a health area]

OBJECTIVES

To conduct a pilot study of telephone consultation in the paediatric population of an urban health centre. To evaluate the telephone consultation as an effective tool when it comes to exercising prior triage of patients requiring urgent attention.

MATERIAL AND METHODS

The study was conducted in two phases. In the first, data were collected from all calls received for six months. In a second phase, we conducted a telephone intervention study to analyse what a random sample of users remembered of the care provided. All those who requested a telephone consultation were included in the study. Demographic, social-welfare, epidemiological, and clinical features, of each patient were recorded. Data were processed using a statistical package SPSS version 17.0 for Windows.

RESULTS

There were 439 telephone inquiries in our pilot project, of which 35.1% were attended by residents, 36% by paediatricians, and 28.9% by paediatric nurses. There were more telephone calls in the afternoons and on weekends. Patients less than or equal to 2 years accounted for 57.9% of cases handled, and there were no differences between sexes. The most frequent reasons for consultation were gastrointestinal symptoms, fever and respiratory problems. The health problem was resolved in 85.8% of cases, requiring only home care instructions, and only 13.3% of children were referred to emergency services. We obtained a mean score of satisfaction of 9.2.

CONCLUSIONS

The pilot project had a high level of satisfaction and resolution, demonstrating cost savings by reducing 55% of face to face visits, with a saving of 35.2 euros per telephone consultation. A teleconsultation model for dealing with emergencies in primary care by telephone would be comparable to a practice staffed by trained paediatric nurses.