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Objective: To determine the prevalence of frequent Paediatric Emergency Departments users and to analyse their characteristics, comparing initial consultations and re-consultations. Methods: This is a multicentre retrospective cohort study of all patients who made 10 or more visits to the Paediatric Emergency Departments of 5 public hospitals between 1 January 2013 and 31 December 2013. An analysis was performed on the patient demographics and clinical data of the first consultation and consecutive re-consultations. Results: Frequent users represented 0.60% (95% CI: 0.56–0.64%) of Emergency Department users, and accounted for 3.93% (95% CI: 3.47–4.39%) of all visits. The most numerous age group consisted of children under 2 years old (66.6%). Frequent users distributed their visits throughout the year (62.3%; P

Resumen: Objetivo: Determinar la prevalencia de hiperfrecuentadores en urgencias y analizar sus características, comparando secundariamente las primeras consultas y las reconsultas. Método: Estudio multicéntrico de cohorte retrospectivo. Se cuantifican las visitas a urgencias de pediatría de 5 hospitales públicos entre el 1 de enero y 31 de diciembre de 2013 y se seleccionan los pacientes con 10 o más visitas realizadas. Se recogen variables demográficas y clínicas y se analiza cada visita en función de si se trata de una primera consulta o una reconsulta. Resultados: Los pacientes hiperfrecuentadores constituyeron el 0,60% (IC 95%: 0,56-0,64%) de los usuarios de urgencias y generaron el 3,93% (IC 95%: 3,47-4,39%) de las consultas. Los menores de 2 años fueron el grupo de edad más numeroso (66,6%). Distribuyeron sus consultas durante los 4 trimestres (62,3%; p

The objectives of this study were (1) to determine the percentage of emergency department (ED) visits due to musculoskeletal pain (MSP) by children 3-14 years of age during a period of 1 year; (2) to determine the most frequent presenting complaints; and (3) to characterize their etiology. A cross-sectional study was performed on children aged 3-14(11/12) years attended at the ED of a tertiary hospital due to MSP. The demographic and clinical characteristics of the patients were reviewed 5 days each month for 12 consecutive months. Study days were selected by computer-generated simple random sampling. Out of 4,531 visits to the ED, 826 were due to MSP (18.2 %; 95 % CI 17.1-19.4 %). When compared with children with no skeletal complaints, children with MSP had a similar sex distribution but were older (mean ± SD 7 ± 3.5 years vs 9.9 ± 3.1 years; p < 0.0001). The most common complaints were pain at the wrist (19 %), ankle (19 %) and finger (15 %). The most common etiology was trauma (88.4 %), including contusions (38 %), fractures (21 %) and sprains (18 %). Children with hip (6.7 ± 3 years; p < 0.0001) and elbow (7.8 ± 3.5 years; p < 0.0001) complaints were younger than children with pain in other locations, whereas children with wrist pain (10.5 ± 2.6 years; p < 0.002) and joint sprains (10.7 ± 2.7 years; p < 0.0001) were older. Fractures were more frequent in boys (64 vs 36 %, p = 0.008; OR 1.6; CI 1.1-2.2). Visits to the ED due to MSP increased with age. Pain at three locations represented 50 % of the presenting complaints. Trauma was the principal etiology, but fractures only represented one-fifth of the total.

Objetivos. Determinar si una vacuna contra la influenza disminuye significativamente los episodios de infección respiratoria superior aguda (IRSA) y la incapacidad laboral por esta causa, en trabajadores adultos sanos de una entidad bancaria en la ciudad de Medellín. Métodos. Se realizó un estudio aleatorizado con doble enmascaramiento y placebo en 493 voluntarios. Mediante asignación aleatoria se conformaron dos grupos, uno de estudio y otro de control, con 247 y 246 empleados, respectivamente. Se utilizaron por participante dosis de 0,5 mL de una vacuna contra la influenza que contiene antígenos de superficie de las cepas recomendadas por la OMS para el período 1996-1997 con los subtipos A/Wahan/359/95 (H3N2), A/Texas/36/91 (H1N1) y B/Beijing/184/93. Se consideró episodio de IRSA cuando algún participante refería dolor de garganta, fiebre y tos con más de 24 horas de duración. La evaluación se realizó quincenalmente durante seis meses; la gravedad de los episodios se estudió por el ausentismo laboral debido a IRSA, según la novena Clasificación Internacional de Enfermedades (CIE-9), mediante la evaluación mensual de las ausencias laborales por incapacidad certificada por la Seguridad Social en Salud, a lo largo de un año. Resultados. La descripción de los efectos colaterales asociados con la vacuna fueron el eritema (riesgo relativo (RR) = 8,0; P = 0,02) y el edema local (RR = 4,5; P = 0,03). La incidencia acumulada anual de los episodios de IRSA fue 78,5% para los vacunados y 91,5% para el grupo placebo, con una reducción de 14%, observándose valores entre 7 y 20% (RR = 0,86; IC95%: 0,80-0,93). La incidencia acumulada anual de IRSA con discapacidad fue de 15,8% en el grupo de vacunados, con una reducción de 31% respecto al grupo placebo (22,8%), con valores entre 0 y 52% (RR = 0,69; IC95%: 0,48-1,0). Estos niveles de protección, tanto contra las formas menos sintomáticas de IRSA como contra las causantes de incapacidad laboral, aumentaron de manera significativa (entre 62 y 89%) en los meses de mayo y octubre, cuando se confirmaron en Colombia brotes originados por el virus de la influenza. Conclusiones. Los resultados demostraron que la estrategia de inmunización con la vacuna disminuyó los episodios y el número de ausencias por incapacidad laboral debido a IRSA en adultos sanos trabajadores de una entidad bancaria en la ciudad de Medellín. El impacto de la influenza en este grupo poblacional es pequeño y el efecto de esta medida es mayor cuando se encuentra en circulación el virus.Objective. To determine if a vaccine against influenza significantly decreases episodes of acute upper respiratory infection (AURI)) and work absenteeism caused by AURI, in healthy adult employees of a banking entity in the city of Medellín, Colombia. Methods. This was a double-blind randomized placebo-controlled study with 493 volunteers. The volunteers were randomly assigned to two groups, an experimental group and a control group, with 247 and 246 employees, respectively. The experimental group participants received a dose of 0.5 mL of an influenza vaccine containing surface antigens of the strains recommended by the World Health Organization for the 1996-1997 period, with subtypes A/Wuhan/359/95 (H3N2), A/Texas/36/91 (H1N1), and B/Beijing/184/93. An illness was considered an episode of AURI when a participant reported having a sore throat, fever, and a cough lasting more than 24 hours. Evaluations were made every 2 weeks over a 6-month period; the severity of the episodes was assessed in terms of lost workdays due to AURI (defined according to the ninth revision of the International Classification of Diseases, or ICD-9), through monthly evaluations of incapacitating work absences certified by the Colombian Social Security system, over the period of a year. Results. Side effects associated with the vaccine were erythema (relative risk (RR) = 8.0; P = 0.02) and local edema (RR = 4.5; P = 0.03). The proportion of the annual cumulative incidence of episodes of AURI was 78.5% for the vaccinated persons and 91.5% for those in the placebo group, with a reduction of 14%, with values between 7% and 20% (RR = 0.86; 95% confidence interval (CI) = 0.80-0.93). The annual cumulative incidence of incapacitating AURI was 15.8% in those vaccinated, with a reduction of 31% in comparison to the placebo group (22.8%), with values between 0% and 52% (RR = 0.69; 95% CI = 0.48-1.0). These levels of protection, both against more mildly symptomatic forms of AURI and those causing lost workdays, increased significantly (between 62% and 89%) in the months of May and October, when outbreaks caused by the influenza virus were confirmed in Colombia. Conclusions. The results demonstrated that the influenza vaccination strategy decreased the AURI episodes as well as the number of work absences due to AURI in the healthy adult employees of a banking entity in the city of Medellín, Colombia. The impact that influenza has on this population group is small, and the effect of this vaccination measure is greater when the influenza virus is in circulation.