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Shirreff G, Huynh BT, Duval A, Pereira LC, Annane D, Dinh A, Lambotte O, Bulifon S, Guichardon M, Beaune S, Toubiana J, Kermorvant-Duchemin E, Chéron G, Cordel H, Argaud L, Douplat M, Abraham P, Tazarourte K, Martin-Gaujard G, Vanhems P, Hilliquin D, Nguyen D, Chelius G, Fraboulet A, Temime L, Opatowski L, Guillemot D. Assessing respiratory epidemic potential in French hospitals through collection of close contact data (April-June 2020). Sci Rep 2024; 14:3702. [PMID: 38355640 PMCID: PMC10866902 DOI: 10.1038/s41598-023-50228-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/17/2023] [Indexed: 02/16/2024] Open
Abstract
The transmission risk of SARS-CoV-2 within hospitals can exceed that in the general community because of more frequent close proximity interactions (CPIs). However, epidemic risk across wards is still poorly described. We measured CPIs directly using wearable sensors given to all present in a clinical ward over a 36-h period, across 15 wards in three hospitals in April-June 2020. Data were collected from 2114 participants and combined with a simple transmission model describing the arrival of a single index case to the ward to estimate the risk of an outbreak. Estimated epidemic risk ranged four-fold, from 0.12 secondary infections per day in an adult emergency to 0.49 per day in general paediatrics. The risk presented by an index case in a patient varied 20-fold across wards. Using simulation, we assessed the potential impact on outbreak risk of targeting the most connected individuals for prevention. We found that targeting those with the highest cumulative contact hours was most impactful (20% reduction for 5% of the population targeted), and on average resources were better spent targeting patients. This study reveals patterns of interactions between individuals in hospital during a pandemic and opens new routes for research into airborne nosocomial risk.
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Affiliation(s)
- George Shirreff
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
- UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, Université Paris-Saclay, Montigny-Le-Bretonneux, France
- Modélisation, Épidémiologie Et Surveillance Des Risques Sanitaires (MESuRS), Conservatoire National Des Arts Et Métiers, Paris, France
| | - Bich-Tram Huynh
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
- UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, Université Paris-Saclay, Montigny-Le-Bretonneux, France
| | - Audrey Duval
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
| | - Lara Cristina Pereira
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
| | - Djillali Annane
- IHU PROMETHEUS, Raymond Poincaré Hospital (APHP), INSERM, Université Paris Saclay Campus Versailles, Paris, France
| | - Aurélien Dinh
- Service de Maladies Infectieuses Et Tropicales, AP-HP. Paris Saclay, Hôpital Raymond Poincaré, Garches, France
| | - Olivier Lambotte
- Service de Médecine Interne Et Immunologie Clinique, AP-HP. Paris Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
- UMR1184, IMVA-HB, Inserm, CEA, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Sophie Bulifon
- Service de Pneumologie, AP-HP. Paris Saclay, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Magali Guichardon
- Service de Gériatrie, AP-HP. Paris Saclay, Hôpital Paul Brousse, Villejuif, France
| | - Sebastien Beaune
- Service Des Urgences Adultes, AP-HP. Paris Saclay, Hôpital Ambroise Paré, Boulogne-Billancourt, France
| | - Julie Toubiana
- Service de Pédiatrie Générale, AP-HP. Centre - Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Elsa Kermorvant-Duchemin
- Service de Réanimation Néonatale, AP-HP. Centre - Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Gerard Chéron
- Service Des Urgences Pédiatriques, AP-HP. Centre - Université Paris Cité, Hôpital Necker-Enfants Malades, Paris, France
| | - Hugues Cordel
- Service de Maladies Infectieuses Et Tropicales, AP-HP. Hôpitaux Universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, Bobigny, France
| | - Laurent Argaud
- Service de Réanimation Adulte, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Edouard Herriot, Lyon, France
| | - Marion Douplat
- Service Des Urgences Adultes, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Paul Abraham
- Service d'Anesthésie-Réanimation, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Edouard Herriot, Lyon, France
| | - Karim Tazarourte
- Service Des Urgences Adultes, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Edouard Herriot, Lyon, France
| | - Géraldine Martin-Gaujard
- Service de Gériatrie, Hospices Civils de Lyon - Université Claude Bernard, Hôpital Edouard Herriot, Lyon, France
| | - Philippe Vanhems
- Service Hygiène, Épidémiologie, Infectiovigilance Et Prévention, Hospices Civils de Lyon - Université Claude Bernard, Lyon, France
- Centre International de Recherche en Infectiologie, Team Public Health, Epidemiology and Evolutionary Ecology of Infectious Diseases (PHE3ID), Univ Lyon, Inserm, U1111, CNRS, UMR5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Delphine Hilliquin
- Service Hygiène, Épidémiologie, Infectiovigilance Et Prévention, Hospices Civils de Lyon - Université Claude Bernard, Lyon, France
| | - Duc Nguyen
- Service Des Maladies Infectieuses Et Tropicales, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | | | | | - Laura Temime
- Modélisation, Épidémiologie Et Surveillance Des Risques Sanitaires (MESuRS), Conservatoire National Des Arts Et Métiers, Paris, France
- PACRI Unit, Conservatoire National Des Arts Et Métiers, Institut Pasteur, Paris, France
| | - Lulla Opatowski
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France
- UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, Université Paris-Saclay, Montigny-Le-Bretonneux, France
| | - Didier Guillemot
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion, Université Paris Cité, Paris, France.
- UVSQ, Inserm, CESP, Anti-Infective Evasion and Pharmacoepidemiology Team, Université Paris-Saclay, Montigny-Le-Bretonneux, France.
- Department of Public Health, Medical Information, Clinical Research, AP-HP. Paris Saclay, Paris, France.
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Oualha M, Bendavid M, Berteloot L, Corsia A, Lesage F, Vedrenne M, Salvador E, Grimaud M, Chareyre J, de Marcellus C, Dupic L, de Saint Blanquat L, Heilbronner C, Drummond D, Castelle M, Berthaud R, Angoulvant F, Toubiana J, Pinhas Y, Frange P, Chéron G, Fourgeaud J, Moulin F, Renolleau S. Severe and fatal forms of COVID-19 in children. Arch Pediatr 2020; 27:235-238. [PMID: 32518045 PMCID: PMC7269941 DOI: 10.1016/j.arcped.2020.05.010] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
Objectives The aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging findings, as well as the disease management and outcomes. Methods This was a retrospective, single-center, observational study conducted in a pediatric intensive and high-dependency care unit (PICU, HDU) in an urban hospital in Paris. All patients, aged from 1 month to 18 years, admitted for confirmed or highly suspected SARS-CoV-2 were included. Results We analyzed the data of 27 children. Comorbidities (n = 19, 70%) were mainly neurological (n = 7), respiratory, (n = 4), or sickle cell disease (n = 4). SARS-CoV-2 PCR results were positive in 24 children (nasopharyngeal swabs). The three remaining children had a chest CT scan consistent with COVID-19. Respiratory involvement was observed in 24 patients (89%). Supportive treatments were invasive mechanical ventilation (n = 9), catecholamine (n = 4), erythropheresis (n = 4), renal replacement therapy (n = 1), and extracorporeal membrane oxygenation (n = 1). Five children died, of whom three were without past medical history. Conclusion This study highlighted the large spectrum of clinical presentation and time course of disease progression as well as the non-negligible occurrence of pediatric life-threatening and fatal cases of COVID-19 mostly in patients with comorbidities. Additional laboratory investigations are needed to further analyze the mechanism underlying the variability of SARS-Cov-2 pathogenicity in children.
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Affiliation(s)
- M Oualha
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France.
| | - M Bendavid
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - L Berteloot
- Pediatric Radiology Department, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France; INSERM U1163, Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, France
| | - A Corsia
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - F Lesage
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - M Vedrenne
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - E Salvador
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - M Grimaud
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - J Chareyre
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - C de Marcellus
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - L Dupic
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - L de Saint Blanquat
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - C Heilbronner
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - D Drummond
- Department of pediatric pneumology and allergology, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France; INSERM UMR 1138, Université de Paris, Paris, France
| | - M Castelle
- Department of pediatric Immuno-hematology and rhumatology, Necker-Enfants Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - R Berthaud
- Department of Pediatric Nephrology, Necker-Enfants Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - F Angoulvant
- Pediatric Emergency Department, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France; INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Université de Paris, Paris, France
| | - J Toubiana
- Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - Y Pinhas
- Department of General Paediatrics and Paediatric Infectious Diseases, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - P Frange
- Clinical microbiology laboratory, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France; EHU 7328 PACT, Imagine institute, Université de Paris, Paris, France
| | - G Chéron
- Pediatric Emergency Department, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - J Fourgeaud
- Virology laboratory, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, EHU 7328 PACT, Imagine Institute, University of Paris, Paris, France
| | - F Moulin
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
| | - S Renolleau
- Pediatric Intensive Care Unit, Necker-Enfants-Malades University Hospital, APHP, Centre-Université de Paris, Paris, France
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Le Coz J, Chéron G, Nabbout R, Patteau G, Heilbronner C, Hubert P, Renolleau S, Oualha M. Diagnostic evaluation and management of seizures and status epilepticus in children with known epilepsy or new-onset seizures: A retrospective and comparative analysis. Arch Pediatr 2020; 27:66-71. [PMID: 31964545 DOI: 10.1016/j.arcped.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/21/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to describe and compare the initial management, including clinical/biological investigation and treatment, of new-onset seizures and status epilepticus (SE) in children versus seizures and SE in those with known epilepsy. METHODS This was a retrospective, single-center, observational study conducted in an urban pediatric hospital in Paris. All patients, aged from 1 month to 18 years, admitted to the pediatric intensive care unit, the high-dependency care unit, and those who required hospitalization in the short-term unit of the emergency department between January 1 and December 31, 2014 for seizures and/or SE were included. RESULTS We analyzed the data of 190 children: new-onset seizures (N=118; group A) versus those with known epilepsy (N=72; group B). At least one diagnostic test was performed on 156 patients (82.1%) (group A, N=104, 88.1%; group B, N=52, 72.2%; P=0.05). In group B, blood levels of antiepileptic drugs were measured in 14 of the 38 patients with SE, of whom six were under dosed. Treatments were: first line, diazepam (group A, 80%; group B, 46%; P<0.001); second line, diazepam (group A, 56%; group B, 34%; P=0.02) or clonazepam (group A, 24%; group B, 46%; P=0.001); third line, phenytoin (group A, 54%; group B, 22%; P<0.001) or clonazepam (group A, 18%; group B, 61%; P<0.001). CONCLUSION Diagnostic evaluation and treatment should be individualized for children with known epilepsy.
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Affiliation(s)
- J Le Coz
- Urgences pédiatriques, Hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
| | - G Chéron
- Urgences pédiatriques, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
| | - R Nabbout
- Neurologie pédiatrique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
| | - G Patteau
- Urgences pédiatriques, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
| | - C Heilbronner
- Réanimation et surveillance continue médico-chirurgicales pédiatrique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
| | - P Hubert
- Réanimation et surveillance continue médico-chirurgicales pédiatrique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
| | - S Renolleau
- Réanimation et surveillance continue médico-chirurgicales pédiatrique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
| | - M Oualha
- Réanimation et surveillance continue médico-chirurgicales pédiatrique, Hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75015 Paris, France
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Aurégan C, Thierry B, Blanchard M, Chéron G. [Recurrent laryngeal papillomatosis complicated by decompensated respiratory failure in two children]. Arch Pediatr 2015; 22:1171-5. [PMID: 26385646 DOI: 10.1016/j.arcped.2015.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/16/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
Laryngeal papillomatosis is a rare, potentially severe cause of recurrent laryngeal dyspnea. It should be known as a cause of laryngeal dyspnea resistant to the usual treatments. We report on two pediatric cases of severe laryngeal papillomatosis with respiratory distress and failure. These observations illustrate the importance of early adequate treatment.
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Affiliation(s)
- C Aurégan
- Service des urgences pédiatriques, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
| | - B Thierry
- Service d'ORL, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - M Blanchard
- Service d'ORL, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - G Chéron
- Service des urgences pédiatriques, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris Descartes, 10, rue de l'École-de-Médecine, 75006 Paris, France
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Bocquet N, Angoulvant F, Chéron G. Comment identifier une urgence néphrologique aux urgences? Arch Pediatr 2015; 22:30-1. [DOI: 10.1016/s0929-693x(15)30016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bocquet N, Biebuyck N, Lortat Jacob S, Aigrain Y, Salomon R, Chéron G. Explorations morphologiques après un premier épisode de pyélonéphrite chez l’enfant. Arch Pediatr 2015; 22:547-53. [DOI: 10.1016/j.arcped.2015.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 11/12/2014] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
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Aurégan C, Berteloot L, Pierrepont S, Chéron G. [Xanthogranulomatous pyelonephritis with pyonephrosis in a 4-year-old child]. Arch Pediatr 2014; 22:287-91. [PMID: 25524291 DOI: 10.1016/j.arcped.2014.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 06/18/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022]
Abstract
Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis observed in only a few cases in children. Symptoms are mild, which explains the delay in diagnosis. Diagnosis is based on histology but can be suspected on CT. The treatment is medical and often surgical, with an uncertain renal prognosis. It is therefore imperative to diagnose early. We report the case of a 4-year-old child who presented with xanthogranulomatous pyelonephritis caused by Pseudomonas aeruginosa, which evolved into pyonephrosis, due to inadequate antibiotic therapy. This highlights the importance of understanding this disease and not treating urinary tract infections blindly.
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Affiliation(s)
- C Aurégan
- Service des urgences pédiatriques, hôpital Necker enfants malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
| | - L Berteloot
- Service de radiologie pédiatrique, hôpital Necker enfants malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - S Pierrepont
- Service de néphrologie pédiatrique, hôpital Necker enfants malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
| | - G Chéron
- Service des urgences pédiatriques, hôpital Necker enfants malades, 149, rue de Sèvres, 75743 Paris cedex 15, France; Université Paris-Descartes, 10, rue de l'école de médecine, 75006 Paris, France
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Chéron G, Patteau G, Desmoulins C. Traumatisme crânien chez l’enfant. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Lanneaux J, Naudin J, Pham L, Gillet Y, Bosdure E, Chéron G, Morin L, Carbajal R, Dubos F, Vialet R, Dauger S, Angoulvant F. SFP PC-80 – Critères de gravité du paludisme d’importation pédiatrique en France. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Patteau G, Benoit J, Chéron G. SFP P-170 - Pertinence d’un algorithme décisionnel des traumatismes crâniens du nourrisson. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)72140-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mandelcwajg A, Ménager C, Chéron G. Fièvre boutonneuse méditerranéenne chez un enfant de 3ans. Arch Pediatr 2014; 21:396-8. [DOI: 10.1016/j.arcped.2014.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 10/07/2013] [Accepted: 01/22/2014] [Indexed: 11/26/2022]
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Miramont S, Alvarez JC, Bourgogne E, Chéron G. Intoxication passive à la cocaïne d’un enfant de 25 mois. Arch Pediatr 2013; 20:654-6. [DOI: 10.1016/j.arcped.2013.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/03/2013] [Accepted: 03/19/2013] [Indexed: 11/27/2022]
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Aurégan C, Touzot F, Grévent D, Chéron G. Purpura thrombopénique idiopathique révélé par un syndrome hémorragique sévère chez un nourrisson de sept mois. Ann Fr Med Urgence 2013. [DOI: 10.1007/s13341-012-0254-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Bocquet N, Sergent Alaoui A, Jais JP, Gajdos V, Guigonis V, Lacour B, Chéron G. Étude randomisée comparant un traitement oral et un traitement séquentiel intraveineux puis oral pour le traitement des pyélonéphrites chez l’enfant. Étude de non infériorité. Ann Fr Med Urgence 2012. [DOI: 10.1007/s13341-012-0240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Timsit S, Rougeau T, Grevent D, Chéron G. Hématome sous-dural lié à la pratique de la boxe chez l’enfant : à propos d’un cas. Arch Pediatr 2012; 19:1187-90. [DOI: 10.1016/j.arcped.2012.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 05/25/2012] [Accepted: 08/13/2012] [Indexed: 11/28/2022]
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Chappuy H, Taupin P, Dimet J, Claessens YE, Tréluyer JM, Chéron G. Do parents understand the medical information provided in paediatric emergency departments? A prospective multicenter study. Acta Paediatr 2012; 101:1089-94. [PMID: 22780454 DOI: 10.1111/j.1651-2227.2012.02763.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM We evaluated the extent to which parents understood the medical information about hospitalization of their child in an emergency department and looked for characteristics likely to increase the risk of poor comprehension. METHODS Prospective multicenter study in thirteen paediatric emergency departments. The parents and doctors completed questionnaires based on closed-ended questions with a common core of four items: reasons of hospitalization, diagnosis, treatment and seriousness of child condition. We evaluated concordance between parents and doctor answers for these items by comparing their responses. RESULTS This study included 380 parents. Percentage of concordance was 55% for the reason of hospitalization, 78% for the diagnosis, 92% for the treatment, 48% for the seriousness of the condition and 19% for all four items. The mean number of concordant items was 2.76 (CI 95%, 2.66-2.86). Parents whose children seemed not in pain and parents who received additional information from the nurse showed significantly slightly higher levels of concordance with doctor's answers (2.98 vs 2.66, p = 0.006 and 2.89 vs 2.60, p = 0.004, respectively). CONCLUSION This study shows that improvements are required in the clarity of the information delivered to the parents. The assistance of nurses and optimal pain management may help to improve communication.
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Affiliation(s)
- Hélène Chappuy
- Université Paris Descartes, Service d'Urgences Pédiatriques, Hôpital Necker Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France.
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Chéron G. [Sedation and analgesia in emergency structure. Paediatry: Which sedation and analgesia for the child under spontaneous ventilation?]. Ann Fr Anesth Reanim 2012; 31:369-76. [PMID: 22464837 DOI: 10.1016/j.annfar.2012.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G Chéron
- Département des urgences pédiatriques, université Paris Descartes Paris-V, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75730 Paris cedex 15, France.
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Vivien B, Adnet F, Bounes V, Chéron G, Combes X, David JS, Diependaele JF, Eledjam JJ, Eon B, Fontaine JP, Freysz M, Michelet P, Orliaguet G, Puidupin A, Ricard-Hibon A, Riou B, Wiel E, de La Coussaye JE. Sédation et analgésie en structure d’urgence. Réactualisation 2010 de la Conférence d’experts de la Sfar de 1999. ACTA ACUST UNITED AC 2012; 31:391-404. [DOI: 10.1016/j.annfar.2012.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aprahamian A, Escoda S, Patteau G, Merckx A, Chéron G. [Minoxidil intoxication, the pharmacological agent of a hair lotion]. Arch Pediatr 2011; 18:1302-4. [PMID: 22001642 DOI: 10.1016/j.arcped.2011.08.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 10/26/2010] [Accepted: 08/11/2011] [Indexed: 11/25/2022]
Abstract
Accidental intoxications in children are frequent but most of them are without serious consequences. We describe herein the case of a young girl who drank 100 mg of a topical hair lotion with minoxidil. On arrival, she had no symptoms except flush on the face and ears. Four and half hours after ingestion, tachycardia appeared with a pulse above 170 beats per min with hypotension at 76/24 mmHg. The heart rate remained between 170 and 190 beats per min for 12 h and then lowered to between 140 and 160 beats per min. Thirty-six hours after ingestion, the heart beat was at 140 beats per min. Minoxidil is a strong vasodilator used first in the 1970s for severe hypertension. It produces hypotension by direct arteriolar vasodilatation. Only a few cases of minoxidil intoxication have been described in the literature, including only one pediatric case. This young boy had only tachycardia of 160 beats per min for 40 h. Most serious cases have been described in adults. They suffered long-lasting tachycardia, hypotension, and ECG changes. Most patients need a bolus of normal saline fluid and some with hemodynamic problems need vasoactive drugs such as dopamine and/or phenylephrine. All patients need to be under medical supervision for a long time because of the product's very long action.
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Affiliation(s)
- A Aprahamian
- Service des urgences pédiatriques, hôpital Necker-Enfants-Malades, université Paris-Descartes, France.
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Escoda S, Guedj R, Blakime P, Chéron G. Échographie rénale aux urgences pédiatriques. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)71046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chéron G, Bocquet N. Pyélonéphrite du nourrisson et de l’enfant : traitement PO ou IV ? Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)71044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Desmoulins C, Michard-Lenoir AP, Naud J, Claudet I, Nouyrigat V, Chéron G. [Clinical features and outcome of 2009 H1N1 influenza in the pediatric setting. Multicenter prospective study in the ED]. Arch Pediatr 2011; 18:505-11. [PMID: 21458977 DOI: 10.1016/j.arcped.2011.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 12/13/2010] [Accepted: 02/11/2011] [Indexed: 01/14/2023]
Abstract
STUDY OBJECTIVE The clinical manifestations and outcome of infants and children with confirmed 2009 H1N1 influenza in emergency departments is described. METHODS We conducted a prospective multicenter case series involving children with symptoms of influenza-like illness in whom 2009 H1N1 influenza was diagnosed on reverse-transcriptase polymerase chain reaction assay on a nasopharyngeal swab or nasal aspirates and who were admitted to the ED of four university pediatric hospitals. The following data were collected: age, gender, preexisting chronic conditions (PECs) associated with a high risk for influenza-related complications, clinical symptoms, outcome, antiviral treatment, and complications. We recorded length of cough and fever during a phone-call on day 8. RESULTS Between 1st October and 31st December 2009, 466 children were included. Their median age was 4 years (range, 1 day to 17 years). The median time to consultation was 24h. Of these 466 infants and children, 55 were aged less than three months and 153 had one or more PECs. Asthma was the most frequent condition. Children at risk and children without risk did not differ for complications (28% vs 31%, P>0.05). Respiratory complications (17%) and decompensations of preexisting disease were the most frequent. Infants aged less than three months did not have more complications than infants without PECs. At-risk infants and children were more frequently hospitalized (P<0.02) and the duration of the pediatric ward stay was longer (P<0.02). This was true only for children aged less than three months. Of the hospitalized children, 17 (9%) were admitted to an ICU. Duration of fever (3.8 days) and duration of cough (6.3 days) did not differ according to whether or not children received oseltamivir. CONCLUSION Infants younger than three months of age are not a group at risk for influenza-related complications. Oseltamivir did not reduce duration of symptoms in this population.
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Affiliation(s)
- C Desmoulins
- Service des urgences pédiatriques, université Paris Descartes, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - A-P Michard-Lenoir
- Service de pédiatrie, CASED, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - J Naud
- SMUR pédiatrique, CHU de Bordeaux, hôpital des Enfants, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
| | - I Claudet
- Service d'accueil des urgences pédiatriques, hôpital des enfants, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 9, France
| | - V Nouyrigat
- Service des urgences pédiatriques, université Paris Descartes, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - G Chéron
- Service des urgences pédiatriques, université Paris Descartes, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
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Vivien B, Adnet F, Bounes V, Chéron G, Combes X, David JS, Diependaele JF, Eledjam JJ, Eon B, Fontaine JP, Freysz M, Michelet P, Orliaguet G, Puidupin A, Ricard-Hibon A, Riou B, Wiel E, De La Coussaye JE. Recommandations formalisées d’experts 2010: sédation et analgésie en structure d’urgence (réactualisation de la conférence d’experts de la SFAR de 1999). Ann Fr Med Urgence 2011. [DOI: 10.1007/s13341-010-0019-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nouyrigat V, Patteau G, Bajolle F, Anthoine-Milhommes MC, Chappuy H, Chéron G. [Neurological complications revealing infectious endocarditis: 2 case reports]. Arch Pediatr 2011; 18:401-4. [PMID: 21397467 DOI: 10.1016/j.arcped.2011.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/06/2010] [Accepted: 01/08/2011] [Indexed: 11/24/2022]
Abstract
Neurological signs are reported in less than 20% of infectious endocarditis (IE) cases. The most frequent complications include cerebral infarction, intracerebral hemorrhage, meningitis, and mycotic aneurysm. We describe two patients, one with congenital heart disease and the other with normal heart, who presented neurological manifestations and fever leading to an IE diagnosis. Neurological complications may be the first symptom of infectious endocarditis and are a major factor associated with increased morbidity and mortality. Early diagnosis and early treatment will minimize cardiac and neurological morbidities.
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Affiliation(s)
- V Nouyrigat
- Service des urgences pédiatriques, hôpital Necker-Enfants-Malades, AP-HP, faculté de médecine, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
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Chéron G, Patteau G, Nouyrigat V. Bronchiolite del lattante. EMC - Urgenze 2011. [PMCID: PMC7149004 DOI: 10.1016/s1286-9341(11)70664-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
La bronchiolite è un’infezione virale stagionale delle vie respiratorie basse del lattante. Il suo agente causale principale è il virus respiratorio sinciziale. La comparsa di un distress respiratorio è legata all’intensità della risposta infiammatoria delle vie aeree. Benché si tratti di una malattia frequente, le cause della suscettibilità dei lattanti a questa infezione non sono conosciute. La diagnosi è clinica. Il trattamento è sintomatico in assenza di misure specifiche. I rapporti a medio e a lungo termine di un primo episodio di bronchiolite con le recidive e con l’asma non sono spiegati. Essi potrebbero dipendere dalla natura del virus in causa al momento del primo episodio e da fattori genetici individuali.
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Bocquet N, Sergent Alaoui A, Jais J, Gajdos V, Guigonis V, Lacour B, Chéron G. CL184 - Traitement oral versus parentéral puis oral des pyélonéphrites chez l’enfant. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70339-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
OBJECTIVE To determine the rate of aftercare adherence to prescriptions from a paediatric emergency department and to identify predictors for nonadherence. METHODS Patients discharged from a French paediatric emergency department with at least one oral drug prescription were included. A telephone interview questionnaire was used to determine whether the child had received the treatments according to the prescription. Adherence was assessed according to three items: frequency of drug administration, length of treatment and drug administering method. Complete adherence was defined as adherence to the three items mentioned above, and nonadherent as nonadherent to at least one of the items. Influence of age, sex, pathology, language spoken at home, type of medical insurance, type of medication prescribed, diagnosis, dissatisfaction with the explanation of the medical problem, number of prescribed medications, length of the treatment and number of doses per day was assessed. RESULTS One hundred and five telephone interviews were exploited. The children were 60 boys (57%) and 45 girls (43%). The ages of these 105 children were between 0.2 and 12 years. The most common diagnoses were asthma and pulmonary infection. Complete adherence with the prescription was 36.2%. Three factors were significantly associated with nonadherence (p < 0.05): length of treatment, number of doses per day and male sex. CONCLUSION This study suggests that simplifying treatment schedules is an effective strategy for improving compliance in paediatric emergency departments.
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Affiliation(s)
- H Chappuy
- Service d'Urgences Pédiatriques, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
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Chappuy H, Tréluyer JM, Faesch S, Giraud C, Chéron G. Length of the treatment and number of doses per day as major determinants of child adherence to acute treatment. Acta Paediatr 2009. [PMID: 19912146 DOI: 10.1111/j.1651] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine the rate of aftercare adherence to prescriptions from a paediatric emergency department and to identify predictors for nonadherence. METHODS Patients discharged from a French paediatric emergency department with at least one oral drug prescription were included. A telephone interview questionnaire was used to determine whether the child had received the treatments according to the prescription. Adherence was assessed according to three items: frequency of drug administration, length of treatment and drug administering method. Complete adherence was defined as adherence to the three items mentioned above, and nonadherent as nonadherent to at least one of the items. Influence of age, sex, pathology, language spoken at home, type of medical insurance, type of medication prescribed, diagnosis, dissatisfaction with the explanation of the medical problem, number of prescribed medications, length of the treatment and number of doses per day was assessed. RESULTS One hundred and five telephone interviews were exploited. The children were 60 boys (57%) and 45 girls (43%). The ages of these 105 children were between 0.2 and 12 years. The most common diagnoses were asthma and pulmonary infection. Complete adherence with the prescription was 36.2%. Three factors were significantly associated with nonadherence (p < 0.05): length of treatment, number of doses per day and male sex. CONCLUSION This study suggests that simplifying treatment schedules is an effective strategy for improving compliance in paediatric emergency departments.
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Affiliation(s)
- H Chappuy
- Service d'Urgences Pédiatriques, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
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Affiliation(s)
- G Chéron
- Service des Urgences Pédiatriques, Hôpital Necker Enfants Malades,Université Paris-Descartes, 75743 Paris cedex 15, France.
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Chéron G, Patteau G, Chappuy H, Nouyrigat V. Protocoles aux urgences : intérêts et limites. Arch Pediatr 2009; 16:748-9. [DOI: 10.1016/s0929-693x(09)74136-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chappuy H, Taupin P, Chéron G. SFP-52 – Urgences – Hospitalisation aux urgences pédiatriques : compréhension par les parents des soins apportés à leur enfant et facteurs associés. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nouyrigat V, Duclaux S, Gouarin L, L’excellent B, Marfok I, Mevel S, Rossetini M, Chéron G. SFP-57 – Urgences – Conseils téléphoniques : amélioration des pratiques aux urgences pédiatriques. Arch Pediatr 2008. [DOI: 10.1016/s0929-693x(08)72124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chéron G, Brissaud O, Wille C, Chappuy H. Sédation aux urgences: jusqu'où l'urgentiste peut-il et doit-il aller? Arch Pediatr 2007; 14:732-4. [PMID: 17419016 DOI: 10.1016/j.arcped.2007.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/21/2022]
Affiliation(s)
- G Chéron
- Département des urgences pédiatriques, hôpital Necker-Enfants-malades, APHP, université Paris-V, 149, rue de Sèvres, 75743 Paris cedex 15, France.
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Abstract
Acute cholecystitis is an uncommon occurrence in children. Acute acalculous cholecystitis (AAC) has various etiology; among them are a wide variety of infectious agents. We report the case of a 7-year-old child who presented AAC due to plasmodium falciparum infection. The causes of AAC are discussed.
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Sannier N, Timsit S, Cojocaru B, Leis A, Wille C, Garel D, Bocquet N, Chéron G. Traitement aux urgences des crises d’asthme par nébulisations versus chambres d’inhalation. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.allerg.2005.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grimprel E, de La Rocque F, Romain O, Minodier P, Dommergues MA, Laporte-Turpin E, Lorrot M, Parez N, Caulin E, Robert M, Lehors H, Chéron G, Levy C, Haas H. Modalités de prise en charge des invaginations intestinales aiguës en France en 2004 : enquête commune du Groupe de pathologie infectieuse pédiatrique (GPIP), du Groupe francophone d'urgences et de réanimation pédiatrique (GFRUP) et de la Société française de chirurgie pédiatrique (SFCP). Arch Pediatr 2006; 13:1581-8. [PMID: 17125980 DOI: 10.1016/j.arcped.2006.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the different pathways of management of intussusception (IS) in infants and children in metropolitan France and to identify paediatric emergency centres that might constitute a surveillance network for IS. MATERIAL AND METHODS A questionnaire was sent to 273 paediatric emergency centres distributed across France in 2005. Modalities of diagnosis and treatment of IS had to be precised. RESULTS One hundred and sixty-seven centres (61.2%) responded. The response was given by 131 paediatricians (78.4%) and 36 surgeons (21.6%) working in 38 universitary hospitals (22.7%) and 129 general hospitals (77.2%). The mean number of IS treated in each centre in 2004 was 11+/-13.5 (extr. 0 to 70; median 6). Diagnosis of IS required a collaboration between medical and surgical teams in 51.5% of the centres, but in 40.1% the sole medical team was in charge of the diagnosis. Ultrasonography is used for diagnosis by 98.8% of the centres. Reduction with hydrostatic enema and eventually surgery was performed in the same hospital in 44.3%. Other centres systematically or frequently transferred the patients for reduction, mostly towards universitary hospitals (90%). CONCLUSION The procedures of IS diagnosis are the same everywhere in France but the pathways of therapeutic management do vary, depending on the availability of surgeons and anaesthetists trained in paediatrics on each site. These disparities will probably change with the implementation of the new plan for sanitary organization in children and adolescents in France. Labellized paediatric emergency centres will gather more surgical patients and could eventually constitute an effective surveillance network for IS.
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Affiliation(s)
- E Grimprel
- Service de Pédiatrie, Hôpital Armand-Trousseau, 26, avenue du Docteur-Arnold-Netter, 75012 Paris, France.
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Cohen R, Romain O, Levy C, Perreaux F, Decobert M, Hau I, Lécuyer A, Lesprit E, Maman L, Roullaud S, Chéron G, Bekri A, d'Athis P, Henriquet V, de La Rocque F. [Impact of CRP rapid test in management of febrile children in paediatric emergency units of Ile-de-France]. Arch Pediatr 2006; 13:1566-71. [PMID: 17070024 DOI: 10.1016/j.arcped.2006.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 09/15/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Fever is a common cause of children visits to emergency units. Clinical evaluation does not always eliminate a bacterial infection. Among blood markers, several publications showed the interest of CRP. This study was undertaken to evaluate correlation between two techniques of CRP, one by usual technique at the laboratory and the other by a rapid test, and to evaluate the impact of this rapid test for febrile children at the emergency room, when a hospitalization was not immediately decided. MATERIAL AND METHODS The study was undertaken in 2004-2005 in eight emergency paediatric units in Ile-de-France concerning febrile children during two periods. In period A, children had at the same time a CRP dosage through two methods, whereas in period B, only a rapid CRP test was first managed. The test used was NycoCard CRP Single test (Progen Biotechnique). RESULTS Between September 2004 and June 2005, 572 children were included, 268 in period A and 304 in period B. Comparison of CRP results by the two methods showed for 247 children (93%) a fairly good linear correlation (r: 0.929). Blood cell count was the most often prescribed test (99.4 vs 10.5%). Conversely to chest radiography, blood culture, fibrinogen and urinary test were significantly most frequent in period A. The average cost of the additional examinations was 2.6 times more important during the first period. Duration of children management in the units was approximately two times shorter when rapid CRP test was used (199.7+/-92.8 vs 103.5+/-98.6 min). CONCLUSION This study shows the interest of rapid CRP test for febrile children in the emergency units, and has to be confirmed in ambulatory paediatric practice.
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Affiliation(s)
- R Cohen
- Service de Bactériologie, Hôpital Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
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Mégarbane B, Donetti L, Blanc T, Chéron G, Jacobs F. Intoxications graves par médicaments et substances illicites en réanimation. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.reaurg.2006.07.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Stheneur C, Armengaud JB, Castro C, Chéron G, Chevallier B. Erreurs de prescription médicamenteuse en pédiatrie hospitalière : enquête prospective multicentrique. Implications pour la prévention. Arch Pediatr 2006; 13:1294-8. [PMID: 16942866 DOI: 10.1016/j.arcped.2006.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 06/26/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To improve the knowledge of medication errors in paediatrics: rate of occurrence, error characteristics, risk factors. PATIENTS AND METHODS Our prospective study included nine uninformed teaching paediatric wards (general paediatrics, emergency departments, intensive care units) using a describing questionnaire built from medical reports analysis (event description, medical issues, contributing personal and structural factors) during a two-months period. RESULTS Seventy-five questionnaires were collected and analysed. Medical errors reported concerned prescription: 21 cases and administration: 45 cases. Ten errors led to adverse effects. An attributable factor was noted in 39 cases. Concerning prescription errors, no respect to protocol: 11 cases, lack of knowledge: 3 cases, personal communication failure: 3 cases were noted. Concerning administration errors, human mistakes (lack of experience, miscommunication, calculation error): 8 cases, unclear prescription: 6 cases and system flaws: 6 cases were noted. Several attribuable causes were reported in 8 cases. CONCLUSIONS Medication errors in paediatrics inpatients are common and contributing factors intricated. Paediatricians should help hospitals develop effective programs for safety providing medications, reporting medication errors, errors analysis strategy and creating a safe environment of medication for all hospitalised paediatric patients.
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Affiliation(s)
- C Stheneur
- Service de Pédiatrie, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise-Paré, 8, Avenue du Général-de-Gaulle, 92100 Boulogne-Billancourt, France
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Brun-Ney D, Beaujouan L, Simon N, Claessens Y, Kierzek G, Chéron G. D2-3 - Utilisation de groupes syndromiques pour la surveillance épidémiologique des urgences. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76842-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Chéron G, Bengoetxea A. Vieillissement et contrôle cérébral de l'exercice. Sci Sports 2006. [DOI: 10.1016/j.scispo.2006.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Beaujouan L, Brun-Ney D, Chéron G, Joubert P, Midan S, Camphin P. E1-1 - Impact des vacances scolaires sur l’évolution de l’épidémie de bronchiolite en Ile-de-France, étudié par le truchement des recours aux urgences. Rev Epidemiol Sante Publique 2006. [DOI: 10.1016/s0398-7620(06)76852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Affiliation(s)
- G Chéron
- Département des urgences pédiatriques, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
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Cojocaru B, de Blic J, Scheinmann P, Chéron G. [Prospective comparison of child asthma education in the emergency department and at scheduled follow-up consultation]. Arch Pediatr 2006; 13:1112-7. [PMID: 16697621 DOI: 10.1016/j.arcped.2006.03.151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 03/15/2006] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess asthma control in asthmatic children attending the emergency department and to compare it with that for children with scheduled specialist follow-up. POPULATION AND METHODS Between September 2002 and September 2003, we included asthmatic children aged 6 to 16 years, attending the emergency department (group U) or pulmonology follow-up appointments (group C) at Necker Hospital, Paris, France. We used the Asthma Therapy Assessment Questionnaire (ATAQ), completed by the parents and children aged 10 years and over. RESULTS We interviewed 156 families and included 144 (92%) in the final analysis (77 in group U). The 2 groups did not differ in age, sex ratio, age at onset and asthma diagnosis and the frequency of asthma attacks. Children in group U received less daily maintenance treatment (P<0.01) but reported more severe asthma (P<0.05). They had also experienced fewer investigations for their asthma (fewer lung function tests P=0.01 and allergy tests P=0.001). The children in group C had better controlled asthma, as assessed by both the children themselves and their parents. They also had fewer problems relating to the behavior, communication and treatment control domains. The assessment of children and parents were similar in all areas except communication. The children considered their communication problems to be more serious than their parents did. Age-related differences were observed, with older children's parents having more difficulties in all domains investigated. CONCLUSION Clinicians should consider assessing asthma control in children attending the emergency department. There is clearly an opportunity to improve the quality of asthma education for these children. Clinicians could provide children with a written plan of action for asthma attacks and information about daily self-management. Improving communication between children, their parents and doctors should be considered a key educational project.
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Affiliation(s)
- B Cojocaru
- Université Paris-Descartes, faculté de médecine, APHP, département des urgences pédiatriques, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France
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Chalumeau M, Holvoet L, Chéron G, Minodier P, Foix-L'Hélias L, Ovetchkine P, Moulin F, Nouyrigat V, Bréart G, Gendrel D. Delay in diagnosis of imported Plasmodium falciparum malaria in children. Eur J Clin Microbiol Infect Dis 2006; 25:186-9. [PMID: 16525777 DOI: 10.1007/s10096-006-0105-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The study reported here prospectively evaluated the time-to-diagnosis of imported Plasmodium falciparum malaria in children in seven French pediatric emergency departments during a 1-week period. For the 29 patients included, the mean patient, doctor and total delays were 3.1, 1.5 and 4.7 days, respectively. The late medical diagnosis for 11 patients was mainly due to the treating physician's failure to consider malaria, despite having been informed that the child had been in an endemic area, and erroneously making a diagnosis of viral infection. The five patients who were diagnosed correctly without delay had higher mean platelet counts than the others (206,000 vs 118,541/mm(3); p=0.008). The results indicate that greater awareness of the risk of malaria in returning travelers may help reduce delays in diagnosis and its consequences.
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Affiliation(s)
- M Chalumeau
- Institut National de la Santé et de la Recherche Médicale U149, 123 boulevard de Port-Royal, 75014 Paris, France.
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Sannier N, Timsit S, Cojocaru B, Leis A, Wille C, Garel D, Bocquet N, Chéron G. [Metered-dose inhaler with spacer vs nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department]. Arch Pediatr 2006; 13:238-44. [PMID: 16423517 DOI: 10.1016/j.arcped.2005.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 12/17/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma. METHODS In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15mg/kg) or puffs of a beta 2 agonist (salbutamol 50 microg/kg or terbutaline 125 microg/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO(2), respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later. RESULTS Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N=40, spacer N=39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (P<0.02). The overall length of stay in the emergency department was significantly shorter (148+/-20 vs 108+/-13 min, P<10(-9)). CONCLUSIONS The administration of beta 2 agonist using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education.
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Affiliation(s)
- N Sannier
- Université Paris-Descartes, Faculté de Médecine, APHP, Hôpital Necker-Enfants-malades, Département des Urgences Pédiatriques, 149, rue de Sèvres, 75743 Paris cedex 15, France
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Affiliation(s)
- H Chappuy
- Département des urgences pédiatriques, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, AP-HP, Université Paris-V, France.
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Affiliation(s)
- H Chappuy
- Département des urgences pédiatriques, hôpital Necker-Enfants Malades, 149, rue de Sèvres, 75743 Paris cedex 15, université Paris V, Paris, France.
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