Manual De Urgencias Pediatricas Hospital La Paz
The Spanish Association of Pediatrics has as one of its main objectives the dissemination of rigorous and updated scientific information on the different areas of pediatrics. Annals of Pediatrics is the Body of Scientific Expression of the Association and is the vehicle through which members communicate. Publishes original papers on clinical research in pediatrics from Spain and Latin American countries, as well as review articles prepared by the best professionals in each specialty communications and annual meeting minute books of the Association, and practice guidelines developed by the various Societies / Sections Specialized integrated into the Spanish Association of Pediatrics. The magazine, referring to the Spanish-speaking pediatric, indexed in major international databases: Index Medicus / Medline, EMBASE / Excerpta Medica and Spanish Medical Index. IntroductionHaemophilia is a rare disease and its management can pose a challenge to Emergency Department paediatricians. AimTo describe the frequency and reasons for consultation by haemophilic children in the ED.
Materials and methodsLongitudinal retrospective study was conducted in a paediatric Emergency Department of a tertiary care hospital. The study included haemophiliacs A and B, ages 0 to 16 years old, and who had consulted the Emergency Department for whatever reason over a span of 6 years (2011–2016). The data analysed include: age, type and severity of haemophilia, reason for query, prophylactic status, complementary examinations, established diagnosis, treatment, and number of visits to the Emergency Department.
ResultsThe analysis included 116 males with a total of 604 Emergency Department visits. The mean age was 5.5 years, and the median age was 5.3 years. A total of 101 patients were categorised as haemophiliac A (38 mild, 4 moderate, 59 severe), and 15 as haemophiliac B (9 mild, 3 moderate, 3 severe).
The main reasons for initial Emergency Department visits (ranked by triage) were: musculoskeletal problems/injury or bleeding (66.7%), causes unrelated to haemophilia (29%), suspected central venous catheter related infection (2.8%), and routine clotting factor infusion (1.5%). Additional tests were conducted during 335 visits (55.5%). Factor replacement was undertaken in 317 visits (52.5%). Haralambos and holborn sociology themes and perspectives 8th edition pdf. A total of 103 episodes (17.1%) required hospital admission, due to: head trauma (35.9%), central venous catheter -related infection (13.6%), haemarthrosis (8.7%), muscle haematoma (6.8%), and haematuria (5.8%).
ConclusionHaemophilic patients went to the Emergency Department for common paediatric causes, but also requested consultation on specific problems related to haemophilia, with musculoskeletal problems/injury or bleeding being the main issues. The paediatric Emergency Department is an indispensable component of haemophilia care. Diagnostic testsOut of all visits, 335 required some type of diagnostic test. Blood tests were performed in 80 visits (13.2%), urinalysis in 16 (2.6%), stool tests in 9 (1.5%) and culture of throat swab or respiratory secretion samples in 19 (3.1%).
Manual De Urgencias Pediatricas Hospital La Paz Zona 14
Imaging tests were performed in 266 visits (44%): musculoskeletal ultrasound examination in 134 (22.2%), musculoskeletal radiographs in 81 (13.4%), head computed tomography (CT) scans in 36 (6%), chest radiographs in 17 (2.8%), abdominal ultrasound in 19 (3.1%), cranial radiograph in 14 (2.3%), abdominal CT scan in 1 (0.2%), neck radiograph in 1 and neck CT scan in 1 (0.2%). Assessment of intracranial haemorrhage: head computed tomographyA head CT scan was performed in 36 visits (corresponding to 31 cases of head trauma, 1 case of polytrauma, 1 patient with afebrile convulsive seizures and 3 patients with persistent vomiting). There was evidence of intracranial bleeding in 7 cases (1.16% of the total visits): subdural haematoma in 5 (in 4 patients following head trauma and in 1 patient with persistent vomiting) and epidural haematoma in 2 (in both cases following head trauma). Presents a brief summary of the cases of intracranial haemorrhage secondary to trauma. In all cases, patients received factor on arrival to the emergency department and before performance of imaging tests. Only 1 of these patients required surgical intervention. Age (years)Type of haemophiliaPXMechanismSymptomsHead CTManagement14.05SHAYesFall from 0.5 mHeadacheSubdural haematomaFactorAdmission to ward28.91MHANoImpact with poleHeadacheSubdural haematomaFactorAdmission to ward33.49MHBNoFall from 17 mSleepinessEpidural haematoma and fractureFactorCraniectomy and drainage of haematoma41.24SHAYesFall from 0.3 mVomitingSubdural haematomaFactorAdmission to ward514.52SHAYesFrontal impact with objectBlurred visionSubdural haematomaAdmission to ward66.37MoHANoBicycle fallVomiting, sleepinessEpidural haematomaFactorAdmission to PICU (did not require surgery).