Anales de pediatria最新文献

英文中文

Infantile orbital hemangioma: A case report 小儿眼眶血管瘤1例。

Anales de pediatria

Pub Date : 2025-10-01 DOI: 10.1016/j.anpede.2025.503967

Rachid Bouchikh-El Jarroudi , Hugo González-Valdivia , Mariana Planells-Alduvín , Mariana Alvarez-Vukov

引用次数: 0

Simulation-based activities: How to get started? 基于模拟的活动：如何开始？

Anales de pediatria

Pub Date : 2025-10-01 DOI: 10.1016/j.anpede.2025.503957

Gema Martínez Espinosa , David Muñoz-Santanach

引用次数: 0

Safety incidents in pediatric emergency departments: Incidence, characteristics, and variability between centers. A national multicenter study 儿科急诊科的安全事件：发生率、特征和中心之间的差异。一项全国性的多中心研究。

Anales de pediatria

Pub Date : 2025-10-01 DOI: 10.1016/j.anpede.2025.503998

Dolores Beteta Fernández , Carlos Pérez Cánovas , Rosa Belén Martínez Egea , Julián Alcaraz Martínez , Adriana Catarina De Souza Oliveira , Manuel Pardo Rios , Grupo de Trabajo RISeuP-SPERG

Introduction

Pediatric emergency departments are high-risk environments for patient safety due to the workload, time pressure and clinical vulnerability of the population. However, there is limited evidence regarding the prevalence, characteristics and associated factors of safety incidents in this setting. Understanding these events is essential to design effective improvement strategies.

Objective

To estimate the incidence of patient safety incidents in pediatric emergency departments, describe their characteristics and identify associated factors. Multicenter, observational and descriptive study based on retrospective chart review and structured incident reporting.

Methods

We identified a total of 1102 pediatric patients treated in the emergency departments of nine Spanish hospitals during the second quarter of 2021 were identified. After excluding 49 patients who could not be reached for follow-up, the final sample included 1056 cases. Of these, 90 children experienced incidents related to healthcare, with a total of 94 incidents, as four patients experienced two incidents each. A previously validated tool was used to collect demographic, clinical and organizational data, as well as information on safety incidents. Results: The overall proportion of patients with at least one safety incident was 8.5% (95%CI: 6.0–9.0). Most incidents caused no harm (39%) or mild to moderate harm (46%), and 13% were deemed clearly preventable. Incidents mainly occurred during emergency care and were attributed to organizational, communication or human factors. There were significant differences between hospitals (P < .01), but we found no associations with shift, triage level, or mode of arrival. The hospital continued to be a significant predictor in the multivariate analysis.

Conclusions

Patient safety incidents in pediatric emergency departments are frequent and partly preventable. The variability observed between centers, which persisted after adjusting for the catchment pediatric population and staffing characteristics, suggests the influence of structural and cultural factors specific to each institution. Context-adapted institutional strategies need to be implemented to foster a proactive safety culture and effective risk management.

导读：儿科急诊科由于工作量大、时间压力大、临床易感性强，是患者安全的高危环境。然而，关于这种情况下安全事故的发生率、特征和相关因素的证据有限。了解这些事件对于设计有效的改进策略至关重要。目的：估计儿科急诊科患者安全事件的发生率，描述其特征并确定相关因素。基于回顾性图表回顾和结构化事件报告的多中心、观察性和描述性研究。方法：我们确定了2021年第二季度在西班牙9家医院急诊科接受治疗的1102名儿科患者。在排除了49名无法随访的患者后，最终样本包括1056例。其中，90名儿童经历了与医疗保健有关的事件，共有94起事件，其中4名患者每人经历了两次事件。一种先前经过验证的工具用于收集人口统计、临床和组织数据以及安全事故信息。结果：至少发生一次安全事件的患者总比例为8.5% （95%CI: 6.0-9.0）。大多数事件没有造成伤害（39%）或轻度至中度伤害（46%），13%的事件被认为是完全可以预防的。事故主要发生在急救过程中，可归因于组织、沟通或人为因素。结论：儿科急诊科患者安全事件频发，且部分可预防。在调整了儿科人口和人员配置特征后，各中心之间观察到的差异仍然存在，这表明每个机构特有的结构和文化因素的影响。需要实施适应环境的制度战略，以培养积极主动的安全文化和有效的风险管理。

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引用次数: 0

Pediatric virtual visits: experiences, preferences, and expectations of patients and caregivers 儿科虚拟就诊：患者和护理人员的经验、偏好和期望。

Anales de pediatria

Pub Date : 2025-10-01 DOI: 10.1016/j.anpede.2025.503993

Miren Ibarzabal Arregi , Tregony Simoneau , Jonathan M. Gaffin , María Gimeno Castillo , Isabel Castro Garrido , Claudia María Chaverri Reparaz , Laura Moreno-Galarraga

Introduction

Virtual visits (VVs) were used during the pandemic as an alternative to face-to-face visits. Following this experience, the implementation of this type of telemedicine in pediatric care may offer clear advantages and benefits, but it is important to understand the perspectives of both patients and caregivers.

Material and methods

Cross-sectional descriptive with data collection through an online questionnaire distributed via QR code and hosted on REDCap completed anonymously by parents/legal guardians and adolescents (n = 426). We obtained data on sociodemographic characteristics, previous experience with telemedicine and the perceived usefulness of VVs from 316 caregivers and 110 adolescents. We analyzed the associations with demographic variables and performed comparative analyses.

Results

Both groups considered VVs a useful alternative, particularly when it came to primary care and hospital-based follow-up. Caregivers highlighted saving time (53%) and reducing school absenteeism (40%) as the main advantages, whereas adolescents emphasized reducing the environmental impact associated with the visit (48%). The ideal duration was estimated at 5–15 min, and more than 95% agreed that VVs should be offered as a voluntary option. We found a higher level of acceptance among caregivers who were younger, with higher educational attainment, who did not have a private vehicle or who had greater difficulty accessing the hospital. The main concern did not involve data breaches or aspects related to confidentiality (10%), but the possibility of missing the call and therefore the appointment (33%).

Conclusions

Both patients and caregivers support the integration of VVs in pediatric care, provided they remain a voluntary and complementary alternative to in-person care. Future programs should consider user preferences, suggestions and the actual barriers they perceive.

导言：大流行期间使用虚拟访问（VVs）作为面对面访问的替代方法。根据这一经验，在儿科护理中实施这种类型的远程医疗可能会提供明显的优势和好处，但重要的是要了解患者和护理人员的观点。材料和方法：横断面描述性，通过REDCap上的在线问卷收集数据，问卷通过二维码分发，由父母/法定监护人和青少年匿名填写（n = 426）。我们从316名护理人员和110名青少年中获得了社会人口学特征、远程医疗的既往经验和视频视频的感知有用性的数据。我们分析了与人口统计学变量的关系，并进行了比较分析。结果：两组都认为VVs是一个有用的选择，特别是当它涉及到初级保健和基于医院的随访时。照顾者强调节省时间（53%）和减少缺勤（40%）是主要优势，而青少年强调减少与访问相关的环境影响（48%）。理想的持续时间估计为5-15分钟，超过95%的人同意视屏应该作为一种自愿选择。我们发现，更年轻、受教育程度更高、没有私家车或去医院更困难的护理人员接受度更高。主要的担忧不涉及数据泄露或与保密相关的方面（10%），而是可能错过电话，因此错过约会（33%）。结论：患者和护理人员都支持儿科护理中VVs的整合，只要他们仍然是面对面护理的自愿和补充选择。未来的程序应该考虑用户的偏好、建议和他们感知到的实际障碍。

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引用次数: 0

Experience with interleukin-1 blockade in refractory Kawasaki disease 白细胞介素-1阻断治疗难治性川崎病的经验

Anales de pediatria

Pub Date : 2025-10-01 DOI: 10.1016/j.anpede.2025.503988

Carlos Baena-Palomino, Lorena Estepa-Pedregosa, Ana Castellano-Martínez, Moisés Rodríguez-González

引用次数: 0

The correlation between the vitamin D/insulin ratio and central precocious puberty in girls and its screening potential 维生素D/胰岛素比值与女孩中枢性性早熟的相关性及其筛查潜力

Anales de pediatria

Pub Date : 2025-10-01 DOI: 10.1016/j.anpede.2025.504016

Jun Sun, Ya Xiao, Shu-Qin Jiang, Hong-Ru Zhang, Jin-Bo Li, Wen-Hui Shi, Wei Wang

Introduction

There are still no effective biomarkers for the diagnosis of central precocious puberty (CPP), and single metabolic indicators (such as vitamin D or insulin) are susceptible to interference from metabolic interactions. We conducted a study to assess the correlation between the vitamin D/insulin ratio (VDIR) and CPP and the screening potential of the VDIR.

Methods

Case-control study in a sample of 170 girls aged 6–10 years, including 85 girls with CPP and 85 girls with normal growth and development. We collected data on growth and developmental indicators and laboratory test results for both groups. The association between the VDIR and CPP/gonadal development was assessed by means of multivariate logistic and linear regression analyses. The diagnostic value of VDIR was evaluated by means of receiver operating characteristic (ROC) curve analysis.

Results

The VDIR in the CPP group was lower than in the control group (3.45 vs 6.18). The area under the ROC curve (AUC) of the VDIR for diagnosis of CPP was 0.731, with a sensitivity of 70.59% and a specificity of 67.06%, higher compared to vitamin D alone (AUC = 0.682) or insulin alone (AUC = 0.690). The multivariate logistic/linear regression analysis revealed that for every 1-unit increase in VDIR, there was a 0.814-fold decrease in the risk of CPP and a 233.54 mm³ decrease in uterine volume.

Conclusion

By integrating the metabolic interactions between vitamin D and insulin, VDIR shows promising value in assessing the risk of CPP. As a potential biomarker, it may offer dual clinical value by enabling early screening of high-risk individuals prior to the definitive diagnosis, as well as providing guidance for personalized interventions.

导语：目前仍没有诊断中枢性性性早熟（CPP）的有效生物标志物，单一代谢指标（如维生素D或胰岛素）容易受到代谢相互作用的干扰。我们进行了一项研究，以评估维生素D/胰岛素比率（VDIR）和CPP之间的相关性以及VDIR的筛选潜力。方法：对170例6 ~ 10岁女童进行病例对照研究，其中85例为CPP女童，85例为正常生长发育女童。我们收集了两组的生长发育指标和实验室测试结果。通过多元逻辑分析和线性回归分析评估VDIR与CPP/性腺发育之间的关系。通过受试者工作特征（ROC）曲线分析评价VDIR的诊断价值。结果：CPP组VDIR低于对照组（3.45 vs 6.18）。VDIR诊断CPP的ROC曲线下面积（AUC）为0.731，敏感性为70.59%，特异性为67.06%，高于单独使用维生素D （AUC = 0.682）或单独使用胰岛素（AUC = 0.690）。多因素logistic/线性回归分析显示，VDIR每增加1个单位，发生CPP的风险降低0.814倍，子宫体积减少233.54 mm3。结论：通过整合维生素D和胰岛素之间的代谢相互作用，VDIR在评估CPP风险方面具有很好的价值。作为一种潜在的生物标志物，它可以提供双重临床价值，既可以在明确诊断之前对高危个体进行早期筛查，也可以为个性化干预提供指导。

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引用次数: 0

Critical appraisal (I): Fundamentals, tools, and application to scientific articles on outcomes and harmful effects 批判性评价(I)：基础，工具，以及对结果和有害影响的科学文章的应用。

Anales de pediatria

Pub Date : 2025-10-01 DOI: 10.1016/j.anpede.2025.503941

Javier González de Dios , María Salomé Albi Rodríguez , Álvaro Gimeno Díaz de Atauri , Laura Cabrera Morente , Elena Pérez González , Carlos Ochoa Sangrador

Evidence-Based Medicine relies on five structured steps: formulating a question, searching for evidence, critical appraisal of the evidence, assessing applicability and evaluating performance. While all steps are essential, critical appraisal is the central component, implemented in three stages: analyzing validity or scientific rigor (including both internal and external validity), evaluating clinical relevance or importance (considering quantitative, qualitative, comparative dimensions, and the balance of benefits, risks, and costs), and determining applicability (in routine clinical practice). Among the useful tools for critical appraisal, notable resources include templates and materials from CASPe and Osteba, as well as the epidemiological calculator Calcupedev, developed by the Committee on Evidence-Based Pediatrics.

This article explores the necessary process of critically appraising studies on prognostic and risk factors through the analysis of observational studies (cohort and case-control studies).

循证医学依赖于五个结构化步骤：提出问题、寻找证据、对证据进行批判性评估、评估适用性和评估绩效。虽然所有步骤都是必不可少的，但关键评估是核心组成部分，分三个阶段实施：分析有效性或科学严谨性（包括内部和外部有效性），评估临床相关性或重要性（考虑定量、定性、比较维度，以及利益、风险和成本的平衡），以及确定适用性（在常规临床实践中）。在批判性评估的有用工具中，值得注意的资源包括来自CASPe和Osteba的模板和材料，以及由循证儿科委员会开发的流行病学计算器Calcupedev。本文通过对观察性研究（队列研究和病例对照研究）的分析，探讨了对预后和风险因素研究进行批判性评估的必要过程。

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引用次数: 0

Critical appraisal (II): Application to scientific articles on therapeutic interventions, systematic reviews and meta-analyses 批判性评价（II）：应用于关于治疗干预、系统评价和荟萃分析的科学文章。

Anales de pediatria

Pub Date : 2025-10-01 DOI: 10.1016/j.anpede.2025.503891

Álvaro Gimeno Díaz de Atauri , María Salomé Albi Rodríguez , Elena Pérez González , Jaime Javier Cuervo Valdés , Juan Ruiz-Canela Cáceres , Javier González de Dios , Comité de Trabajo de Pediatría Basada en la Evidencia

In this article, we discuss the methodology for the critical appraisal of clinical trials (CTs) and systematic reviews (SRs). Studies of either type, when well designed and executed, provide the best evidence for clinical decision-making. Clinical trials are the primary source of evidence for evaluating therapeutic interventions, and SRs analyze and synthesize research of a certain quality to answer a specific clinical question. To assess their validity, it is essential that they aim to answer a specific question in terms of population, intervention and outcomes and that the risk of bias is reduced as much as possible during their development, from design to publication. The article addresses the steps to take to assess whether a CE or SR meets the criteria for its results to be considered reliable (valid). Once their validity is confirmed, the magnitude and clinical relevance of the results must be assessed, in addition to their applicability to our patients in particular.

在本文中，我们讨论了临床试验（ct）和系统评价（SRs）的批判性评价方法。任何一种类型的研究，如果设计和执行得当，都能为临床决策提供最好的证据。临床试验是评价治疗干预措施的主要证据来源，SRs分析和综合一定质量的研究来回答特定的临床问题。为了评估它们的有效性，至关重要的是，它们的目标是回答一个特定的问题，包括人口、干预和结果，并且在它们的开发过程中，从设计到发表，偏见的风险尽可能地降低。本文讨论了评估CE或SR是否满足其结果被认为可靠（有效）的标准所采取的步骤。一旦它们的有效性得到确认，必须评估结果的大小和临床相关性，以及它们对我们患者的适用性。

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Anales de pediatria

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Anales de pediatria

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