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Resume Introduction Devant une importante frequentation du service d’accueil des urgences pediatriques (SAUP) du centre hospitalier universitaire (CHU) Lenval a Nice, il a ete instaure un systeme de circuit court avec des consultations delocalisees (CsD). L’objectif etait d’evaluer l’interet de sa mise en place en termes de duree d’attente et de prise en charge, de satisfaction des patients et des soignants. Methode Etude prospective, mono-centrique realisee en periode d’ouverture des CsD (le week-end de 13 h a 20 h) du 21 janvier au 18 mars 2012. Tous les enfants consultant au SAUP en periode d’ouverture des CsD pour raison medicale ont ete inclus. Parmi les enfants etiquetes stade 5, un sur deux etait transfere aux CsD. Les donnees evaluees ont ete les delais d’attente, la duree de consultation, le temps de passage et la satisfaction des patients et du personnel soignant. Resultats Un total de 875 patients a ete inclus. Les stades 1–2, 3, 4, 5 non delocalises et delocalises avaient respectivement des durees moyennes d’attentes entre la prise en charge par l’infirmiere d’accueil et la consultation medicale de 39,1 ; 57,7 ; 54,8 ; 70,5 et 52,7 minutes (min). La duree moyenne de consultation etait plus longue pour les stades 1–2 (61,6 min). Le temps global passe aux urgences etait plus long pour les stades 5 non delocalises (121,3 min). L’ensemble de la population des urgences (patients et equipe medicale) semblait satisfait par la mise en place des CsD. Conclusion Les delais d’attente et de prise en charge ont diminue pour les patients ayant beneficie des CsD.

Panton-Valentine leukocidin (PVL) is a major toxic virulence factor secreted by community-acquired methicillin-sensitive or methicillin-resistant Staphylococcus aureus (SA). SA-PVL can be responsible for life-threatening infections in healthy children with a wide spectrum of clinical presentations involving lung, skin, and soft tissues or bones and joints. PVL production should always be considered in severe SA infections. The pediatric medicine community remains poorly informed regarding the therapeutic management of this infection, which should be early and aggressive. Intravenous empiric antibiotics against SA and its toxins must be given with early and sometimes iterative surgical procedures to drain abscesses and to stop bacterial proliferation and necrosis in the tissues. Here, we report the cases of three patients admitted for SA-PVL infections to the pediatric intensive care unit. Initial clinical presentation in the three patients was multifocal osteomyelitis associated with necrotizing pneumonia; severe skin infection with septic shock; and non-necrotic pneumonia with pleural and pericardial effusion. Appropriate treatments resulted in a good outcome in all cases. Following these illustrations, we describe a number of practical key points in the optimal medical and surgical management of severe SA-PVL infections, with a review of the literature.

The number of emergency pediatric consultations continues to rise in France. The pediatric emergency department (PED) introduced relocated consultations (RlCs) for unwarranted visits to relieve the overload of emergency medical consultations. The objective of this study was to assess the advantages of implementing these RlCs.A single-center prospective study was undertaken from 21st January to 18 March 2012, with RlCs opened on weekends from 1 to 8 pm in the PED of the Nice Lenval University Hospital Center. All children referred for medical reasons during this period were included. One out of two children labeled stage 5 were transferred to the RlCs. The data evaluated were waiting time, duration of the medical consultation, transit time, and patient and medical staff satisfaction.Eight hundred and seventy-five patients were included. All patients in stages 1-2, 3, 4, and 5, relocated or not, had a mean waiting time before the medical consultation lasting 39.1, 57.7, 54.8, 70.5, and 52.7 min, respectively. The mean duration of the medical consultation was longer for stages 1-2 (61.6 min). The total time spent in the PED did not differ between stage 5 patients who were not relocated (121.3 min) and stages 1-2 (118 min), but both were longer than stage 5 patients who were relocated (90.3 min). Patients and medical staff expressed overall satisfaction during this period.By relocating one out of two stage 5 children, waiting times and consultation times decreased for all patients consulting at the PED. These results confirm that implementing RlCs has improved working conditions and quality of patient management.

Panton-Valentine leukocidin (PVL) is a major toxic virulence factor secreted by community-acquired methicillin-sensitive or methicillin-resistant Staphylococcus aureus (SA). SA-PVL can be responsible for life-threatening infections in healthy children with a wide spectrum of clinical presentations involving lung, skin, and soft tissues or bones and joints. PVL production should always be considered in severe SA infections. The pediatric medicine community remains poorly informed regarding the therapeutic management of this infection, which should be early and aggressive. Intravenous empiric antibiotics against SA and its toxins must be given with early and sometimes iterative surgical procedures to drain abscesses and to stop bacterial proliferation and necrosis in the tissues. Here, we report the cases of three patients admitted for SA-PVL infections to the pediatric intensive care unit. Initial clinical presentation in the three patients was multifocal osteomyelitis associated with necrotizing pneumonia; severe skin infection with septic shock; and non-necrotic pneumonia with pleural and pericardial effusion. Appropriate treatments resulted in a good outcome in all cases. Following these illustrations, we describe a number of practical key points in the optimal medical and surgical management of severe SA-PVL infections, with a review of the literature.

Introduction l’encephalite a anticorps anti-recepteurs NMDA est de plus en plus reconnue comme responsable de divers desordres neuropsychiatriques allant de la psychose a l’etat de mal convulsif et touchant souvent l’adulte jeune. Le mecanisme physiopathologique semble etre auto-immun ou paraneoplasique. Cas clinique un enfant de 5 ans, sans fievre ni syndrome meninge, presentait depuis 5 jours des troubles neurologiques (agitation, enuresie, dysarthrie, troubles de l’equilibre et crises convulsives partielles droites). L’IRM cerebrale et le bilan inflammatoire etaient normaux. La ponction lombaire retrouvait une hyperlymphocytose, une proteinorachie normale, des cultures virales et bacteriennes steriles. La recherche d’anticorps anti-recepteurs NMDA dans le LCR etait positive. Un traitement antiepileptique, des immunoglobulines et une corticotherapie intraveineuses permettaient une lente amelioration sans sequelle ni recidive. La recherche de neoplasies restait negative. Conclusion Une encephalite a anticorps anti-recepteurs NMDA doit etre recherchee devant tout tableau neuropsychiatrique non etiquete. Le diagnostic repose sur la recherche d’anticorps specifiques dans le LCR.