[The concept of damage control in pediatrics: everything a physician needs to know in practice]

The concept of damage control in pediatrics: everything a physician needs to know in practice. After the terrorist attacks in France and the rest of the world, children may be potential targets and be part of the victims. In order to prepare for these situations of «war medicine» our medical training is inadequate. It seems important to draw attention to the care strategy to adopt in these exceptional situations: the concept of «damage control resuscitation» from military experience in conflict zones aims to reduce preventable deaths, using simple and quick gestures. In practice, the goal is to control bleeding sites and to fight against the lethal triad of hypothermia, acidosis and coagulopathy to bring the patient to a minimalist rescue surgery in one hour. The success of this overall strategy depends on effective communication and coordination between pre-hospital teams on site and hospital teams with the sole objective: patient survival by prioritizing medical care and evacuations. Although the experience of damage control is limited in pediatrics, its principles can be applied to the child taking into account the particularities of its own physiology. It seems essential today for every physician, single witness or real frontline actor, to be familiar with these first aid techniques that could save children's lives.

Impact of 2011 French guidelines on antibiotic prescription for acute otitis media in infants

OBJECTIVE

In 2011, new guidelines on antibiotic prescription for acute otitis media (AOM) were published in France to decrease the use of third generation cephalosporins that promote the carriage of extended-spectrum beta-lactamase producing Escherichia coli. Our objective was to assess the impact of the 2011 French recommendations on the type of antibiotics prescribed for AOM.

METHODS

Fourteen thousand six hundred and sixty-one children, 6 to 24 months of age, presenting with AOM were included in 2 studies, between November 1, 2009 and October 31, 2012. The first one was conducted with the support of 62 private practice pediatricians; the second one was conducted in 7 pediatric emergency departments. Three periods of 1 year each were defined.

RESULTS

Antibiotics were prescribed in 12,471 (85.1%) of cases of AOM during the study period. Amoxicillin prescriptions was multiplied by 25, between the first year (2.6%) and the last year (66.1%). Conversely, prescriptions of cefpodoxime proxetil and amoxicillin-clavulanic acid decreased from 33.6% and 62.0% in the first year to 5.2% and 27.7% in the last year, respectively. This trend was observed in both private practices and in the pediatric emergency departments.

CONCLUSION

Amoxicillin became the most frequently prescribed antibiotic for AOM in 2012, complying with the 2011 French guidelines, while the proportion of prescribed broad-spectrum antibiotics decreased. Our study highlights the importance of guidelines to decrease the prescription of broad-spectrum antibiotics, a crucial factor in the prevention of antibiotic resistance.

[Characteristics of admissions to pediatric emergency departments for exacerbations of asthma. Assessment and prospects for improving prehospital care]

INTRODUCTION

The frequency of emergency department visits for asthma is a major public health problem in pediatrics. The aim of this study is to establish the characteristics of children visiting pediatric emergency departments for acute asthma and to assess their therapeutic management prior to admission.

METHODS

A prospective clinical study performed during 3 months at the pediatric emergency department of the university teaching hospital of Clermont-Ferrand, of children aged 1 to 16 years admitted to the department with a clinical diagnosis of asthma exacerbation.

RESULTS

One hundred and forty-three patients were included in the study. Asthma crises were moderate to severe in 69.2% of cases (n=99). Initial therapeutic management prior to the admission to the emergency department was appropriate in 17.5% of cases (n=25). Most of the known asthmatic patients had not been followed up by a pediatric pulmonologist (n=56). A crisis protocol had been set up in 16.5% of cases (n=20). Exacerbations were more severe among younger patients (P=0.002) and economically disadvantaged children (P=0.025).

CONCLUSIONS

This study uncovers poor knowledge of the disease among asthmatic children and their families, and an insufficient awareness among health practitioners of current recommendations for the treatment of asthmatic children. Admissions to the emergency department for asthma could be partly avoided by improving diagnosis and therapeutic education.