Objective: To know if a process change about patients with IV-V levels of triage reduces the waiting time for their assistance.
Material and methods: This was a descriptive observational study. The «winter plan» includes the extension of the care area to an area attached to the Emergency Department. In 2017, it was used on occasion of increases in delay of patients with level IV-V, relocating after triage according to the reason for consultation. In 2018, this area remained open. All patients with level IV-V were visited in this area.
Results: In 2017, 43.2% level IV patients waited <60 minutes and 65.4% level V patients <120 minutes, compared to 49.7% and 76.9% in 2018 (p <0.001). In 2017 there were 4.9% triaged and unvisited patients and 9.3% waited more than three hours, compared to 3.7% and 5.8% in 2018 (p <0.001).
Conclusion: The new process is effective decreasing the delay in patients with levels IV-V.

Correspondencia: V. Arias Constantí. Servicio de Urgencias de Pediatría. Hospital Sant Joan de Déu. c/Passeig Sant Joan de Déu, nº 2. 08950 Esplugues de Llobregat
(Barcelona). Correo electrónico: varias@sjdhospitalbarcelona.org

Introduction: Paediatric head trauma is one of the most common visits in a paediatric emergency department and one of the leading causes of death and disability in children. In the year 2014, a protocol was established in order to reduce radiological examinations without compromising quality care. The purpose of the study is to describe the clinical-radiological characteristics of the patients with head trauma treated after the introduction of the new protocol, to evaluate the changes in the management that it has implied and to evaluate the fulfillment of the new protocol.
Methods: A prospective descriptive observational study of all paediatric mild head traumas (Glasgow Coma Score ≥14) attending a paediatric emergency department during a period of 2 years: October 2014-October 2016. All patients were younger that the age of 14 years at the time of injury and were divided into two age groups (minor and older than 2 years of age). In order to see the impact of the new protocol, the results were compared with a historic group of patients who were treated according to the old protocol.
Results: 1,438 patients fulfilled the inclusion criteria: 490 under 2 years old (34.1%) and 948 older than 2 years old (65.9%). 85 skull radiographs were performed: 8% under 2 years and 4.85% over 2 years; 29% recommended according to the protocol established. 60 CT scans were performed: 1.84% under 2 years and 5.38% over 2 years; most of them recommended according to the protocol. Comparing with the period prior to the introduction of the protocol, the number of radiographies has decreased.
Conclusions: Since the establishment of the new protocol against mild head traumas, the number of radiographies has been reduced. In those with moderate risk of brain injury a clinical observation should be performed and in case of worsening, an imaging test could be recommended, being CT scan the most recommended.

N. Sarrión Sos. Servicio de Pediatría. Hospital General Universitario. Avda. de las Tres Cruces, 2. 46014 Valencia. Correo electrónico: nersasos@gmail.com

Introduction: Patient safety is essential in health system. Incidents are common in daily clinical practice; however, few studies have analyzed the incidence of adverse events (AEs) in the pediatric population. The trigger tools are simple warning signs for suspecting AEs. The aim of this study was to know the sensitivity of this tool adapted to a pediatric emergency department in a tertiary referral hospital.

Patients and methodology: 29 suitable triggers were selected. In total, we studied 140 randomized patients seen in the emergency room between 1 January and 31 July 2015.

Results: 48 triggers were seen in 38 of the 140 clinical files. AEs were detected in 9 histories (one with 2 triggers), almost 21% of medical records that include triggers. The most frequently detected and associated with a higher percentage of AEs was "readmission for the same reason in less than 72 hours after hospital discharge" followed by "inadequate drug dosage".

Conclusions: The trigger tools have not demonstrated profitability for screening of AEs in our hospital. The trigger "readmission for the same reason within 72 hours" seems to be more sensitive to detect potential AEs. Therefore, it would be reasonable to assess the records in which it appears.

Introduction: Measles is a highly contagious infectious dis­ease, associated with an important morbidity and mortality. An effective and safe vaccine is available and its eradication is possible. However, since 2009 measles outbreaks are occur­ring in Europe, with an important number of cases in Spain.
Methods: Retrospective study conducted in an emergency department of a tertiary hospital. We included pediatric patients diagnosed of possible measles during the period January-December of 2011.
Results: We diagnosed 67 suspected measles cases, the 76% of which had typical symptoms like coryza, cough or exanthema. There had been contact with confirmed measles cases in 50% of suspected cases, mainly familiar. The diagnostic was confirmed by laboratory tests in 25 patients, like serology or PCR of nasopharyngeal secretions. Another 25 patients were compatible with measles by clinic or epidemiological vinculum. 90% of confirmed cases took place in unvaccinated patients.12% of possible measles cases were admitted to hospital. Pneumonia was diagnosed in 2 patients.
Conclusions: Our study shows an elevated incidence of measles in a sanitary area and confirms the existence of susceptible population due to a fail in vaccine coverage. To reach the objective of WHO of eradicating measles in 2015 in the European region, an early communication and investigation of suspected cases of measles is necessary. Sanitary professionals must be informed of the existence of an outbreak, because it is an infrequent infection in the daily clinical practice.

Introduction: Traumatic brain injury (TBI) is an important pathology in pediatrics due to its frequency and the associated care burden to managing the derivate consequences.
Target: To determinate the epidemiological characteristics of TBI patients treated in the Pediatric Emergency Service of the new "río Hortega" Hospital of Valladolid, after the recent establishment of a new TBI management protocol.
Material and methods: We carried out a longitudinal observational descriptive study which included 127 patients, over a period of six months, who had been diagnosed with TBI, taking the data from a predefined questionnaire.
Results: The average age of the patients was 3.13 years, mostly male (55.9%). The most common cause was the accidental fall. The clinical appearance is more frequent in children older than two years. Most of the cases were classified as mild (94.5%). Only four hospital admissions were prescribed. No deaths were recorded. The CT was performed in 8.9% of the cases.
Conclusion: The results obtained in this study are similar to the one found in the bibliography. Although we get a lower mortality and morbidity rate and a minor indication of diagnostic tests. Initial neurological exploration and the calculation of the Glasgow Score are still the main tools to set the priority in its therapeutic management and prognosis.

Objective: To evaluate parents' knowledge about asthma.

Material and methods: We delivered the Spanish version of the Newcastle Asthma Knowledge Questionnaire to parents of children with an asthma attack.

Results: The questionnaire was administered to 95 parents (average age of 32.1; 77.7% mothers). The mean score was 16/31. We did not find statistically significant between the score and severity of the asthma attack, need to stay in hospital, previous hospitalization or use of preventive treatment.

39.4% of parents identified correctly the symptoms of an asthma exacerbation. The implication of the bronchospasm and bronchial inflammation in this exacerbation was recognized by 76.6% and 63.8%, respectively. Nevertheless, 47.9 % thought that asthma is a "nervous problem", and 91.5% could not name three triggered factors.

68.1% did not know the names of two medicines useful for an asthma exacerbation, and 41.5% answered that short action 2-agonist are "control medications". 31.9% of these parents did not know about "control medications", 73.4% could not name two of these medicines, and 51.1% answered that antibiotics are an important part in the treatment of asthma.

In addition, 63.8% of these parents believed that cow's milk increases the mucosity, and 25.6% that these patients should not consume dairy produce.

Conclusions: The knowledge of these progenitors was poor; they have false beliefs about the pathogenesis of this disease. Nevertheless, we did not find statistically significant between this low knowledge and the severity of the asthma exacerbation, previous hospitalization or use of "control medications".

Objective: To study the rate of bacterial meningitis among infants aged 0-3 months with suspicion of urinary tract infection.

Methods: This retrospective chart review involved all children younger than 3 months with pathologic rapid urine testing by urethral catheterization in the emergency department. Lumbar puncture was performed in all children <1 month and every child 1-3 months with septic appearance. The study was conducted from October 2004 to July 2010.

Results: The study sample included 290 children with suspicion of urinary tract infection, of whom 76% boys and 24% girls; 43% of all patients were younger than one month. Urinary tract infection was confirmed by positive urine culture in 230 children, 9 of whom (3.2%) had bacteraemia associated. Lumbar puncture was performed on 167 patients (58%), of whom 7 (4%) had CSF pleocytosis. All CSF cultures were negative except of a case of a neonate 24 days old with meningitis and urinary tract infection caused by Escherichia coli.

Conclusions: The incidence of bacterial meningitis among infants aged 0-3 months with suspicion of urinary tract infection was 0.6% in our study. It is important to reconsider the performance of lumbar puncture systematically in these children, although it is still need in children aged less than 1 month and in cases where there is clinical or laboratory test suspicion of serious bacterial infection.

Introduction: Relatives are not usually present during invasive procedures in the Pediatric Emergency Room (ER), although an increasing number of them would like to be. Our goal was to find out how the health care workers in the ER felt about the presence of relatives during invasive procedures.

Material and methods: We carried out an observational study based on anonymous questionnaires distributed among the ER professionals during January and February 2007. The data included demographic and occupational questions, as well as their opinion regarding the influence of the presence of relatives during procedures on the children, the families and the health care workers. The data were analyzed using the SPSS 13.0 statistical software package.

Results: Sixty questionnaires were analyzed. Sixty-two percent of the professionals considered that the presence of relatives has beneficial effects on children, 26% considered that it benefited the professionals and 55% that it benefited the relatives. Fifty-five percent of those surveyed considered that the professional should decide whether relatives can be present. When we compared the groups involved, we found differences depending on the clinical scenario (insertion of an intravenous line, wound suturing, lumbar puncture or cardiopulmonary resuscitation). There were also statistical differences when groups of health care workers were compared (physicians versus non-physicians).

Conclusions: Health care workers consider beneficial the presence of relatives during procedures in the ER, although the benefit is lesser in more invasive procedures. The consideration of this presence is better among physicians than among non-physicians.

These data should be compared with the opinion of relatives.

Objective: To describe the quality of antibiotic prescription in the pediatric emergency service before and after two educational talks regarding "the rational use of antibiotics".

Material and methods: Descriptive, retrospective study of all the discharged patients evaluated in the emergency service during the month of January 2008 compared to December 2008 and January 2009. Demographic, social, diagnostic and treatment parameters of children who received antimicrobials treatment were analyzed. Dosage and indication were evaluated according to the validated clinical guidelines of the hospital, between both periods' formative sessions about the rational use of antibiotics.

Results: In January 2008 we reviewed 5,989 medical discharge records and found that 13% of the children had received antibiotics. We also reviewed 6,359 records from the second period and found that 12.7% of the children had received antibiotic therapy. The most frequent diagnoses were acute pharyngotonsillitis (49.6%) in the first period and acute otitis media (39%) in the second period. The indication and dosage were correct in 90.7% and 79.4% of the cases in the first period compared to 84.7% and 86% in the second period (p

Conclusions: The percentage of antibiotic prescription in this study is similar to that of other series and did not decrease after educational talks regarding the rational use of antibiotics. Although there was an increase in the correct dosage prescribed the percentage of incorrect antibiotic indications increased as well. Further actions should be taken to improve the quality of antibiotic prescriptions.

M.M. Tolín. Hospital Maternoinfantil «Gregorio Marañón». Dr. Castelo, 47. 28009 Madrid.
Correo electrónico: mar_th1981@hotmail.com

Introduction: For several years, there is an increase in visits due to psychiatric disorders in the pediatric emergency departments. Therefore the coordination between pediatric emergency department and mental health department is important to improve the care of pediatric patients with mental illness.

Objectives: To analyze the characteristics of pediatric patients in the Pediatric Emergency Department in our hospital.

Methodology: Transversal and descriptive study of the psychiatric emergencies treated in the Pediatric Emergency Department which required attention by psychiatry of the Corporació Sanitària Parc Taulí (Sabadell) (period 2006-2007). We analyzed social demographic variables, psychiatric diagnoses, as well as the need of treatment and final destination of the patient.

Results: There were 104 psychiatric visits of 93,908 emergencies (0.1%), with a mean age of 12.37 years (range: 6-15). The main reasons for consultation were: worsening of their underlying disease (51%), different kinds of conduct alteration (31.7%) and suicide attempt (17.3%). Many of the cases showed associated factors or social dystocia: 68.2% had family history of psychiatric illness, a 39.4% alcohol or drugs abuse and 25.9% had a traumatic parent divorce. Only 26% of the cases needed drug treatment other than their usual treatment. The main diagnosis at discharge was, in 50% of the cases, unspecified conduct disorder or conversion disorders. A 64% of the patients were discharged, and 36% required admission.

Conclusions: The pediatric psychiatric emergencies are complex and serious. There is an increase of these, which may be due to multiple causes. Some of the causes represent epidemiological trends and can be studied and foreseen.

Introduction: The visits to the emergency services by the newborn babies can cause a great anxiety in their parents and in the emergency department staff. As a result of a shorter postpartum hospital stay, many childcare concerns, which traditionally have been managed in newborn nurseries, are appearing in the pediatric emergency department. The parents' education is fundamental to diminish the anxiety and to solve doubts and concern, and in that form diminish the congestion in these services, costs and all the implications that this brings.

Material and methods: We performed a retrospective study of patients younger than 28 days old of life who were attended at the pediatric emergency department in 2009. Information on sex, age, time and date, parents ethnic group, referral by another medical doctor/center, cause of consultation, complementary examinations, final diagnosis, and patients admission.

Results: There were 415 visits to newborn babies. The mean chronological age was 12.5 days, 51.3 % were boys. Visits were most frequent on evening shifts, and in the months of May and December. The most frequent main complaint was jaundice (15.4%) and changes in intestinal rhythm (14.4%). 27.5% were children of immigrants. The most frequent final diagnoses were childcare concerns (35.9%) and jaundice (15.7%). Complementary examinations were not required in 70.8%.The admission rate was of 12%, most commonly due to jaundice (3.9%) and fever (1.7%).

Conclusions: The vast majority of visits were due to minor problems that did not require complementary examinations and could have been resolved in primary care centers.