Pediatric Emergency Room Research Articles

Child sexual abuse detection in the pediatric emergency room

BackgroundChildren who report sexual abuse are often first evaluated in a Pediatric Emergency Room (ER). ObjectiveThis study aims to describe clinical characteristics and management among these children. Participants and methodsA retrospective review of child sexual abuse (CSA) cases in the ER of a tertiary hospital in Madrid over a 9-year period (January 2011 to April 2020) was conducted. 213 children up to 16 years old were included. Descriptive statistics were performed. ResultsAn 83% of victims were girls, of whom 97.7% reported physical contact. The mean age was 8.5 ± 4.4 years, with two peaks of incidence at ages of 3 and 13. Aggressors were known by the victim in 77.8% of cases. Anogenital lesions were present in 39.9% of children who described physical contact, of which 31.7% were suspicious or specific of CSA. We obtained positive microbiological samples in 41 patients, with 14.6% specific findings for sexually transmitted infections (STIs). 23,9% received prophylaxis for bacterial STIs and 13.6% against HIV. 59.6% were followed-up in outpatient clinics. Since our protocol renovation in 2019, we observe a statistically significant increase in microbiological detection (p < .005) and outpatient follow-up (p < .001). ConclusionsSTIs screening should always be done when physical contact is reported for eventual treatment and perpetrator prosecution, as physical lesions are frequently not found. The optimal treatment of CSA requires the use of renewed specific protocols and the involvement of multidisciplinary trained teams to ensure adequate medical and personal care.

Triage through telemedicine in paediatric emergency care-Results of a concordance study.

BackgroundIn the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many parents use these facilities as they do not know how urgently their child requires medical attention. In recent years, paediatric departments in smaller hospitals have been closed, particularly in rural regions. As a result of this, the distances that patients must travel to paediatric care facilities in these regions are increasing, causing more children to visit an ER for adults. However, paediatric expertise is often required in order to assess how quickly the patient requires treatment and select an adequate treatment. This decision is made by a doctor in German ERs. We have examined whether remote paediatricians can perform a standardised urgency assessment (triage) using a video conferencing system.MethodsOnly acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen’s kappa, between the two paediatricians. We have also included patient and assessor demographics.ResultsA total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician’s and telemedicine paediatrician’s urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient’s condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen’s weighted kappa was 0.64 (95% CI: 0.49–0.79), indicating a substantial agreement between the specialists.ConclusionsTelemedical triage can assist in providing acute paediatric care in regions with a low density of paediatric care facilities. The next steps are further developing the triage tool and implementing telemedicine urgency assessment in a larger network of hospitals in order to improve the integration of telemedicine into hospitals’ organisational processes. The processes should include intensive training for the doctors involved in telemedical triage.Trial registrationDRKS00013207.

Viral exanthems in children

Virale und paravirale Exantheme sind die häufigsten Exantheme des Kindesalters, die auch meist zu einer Vorstellung in der Praxis inklusive der Notaufnahme führen. Die Kenntnis der verschiedenen Krankheitsbilder ist entscheidend für die adäquate Diagnostik und Betreuung der kleinen Patient:innen, die entsprechende Aufklärung der Familie und ggf. das Minimieren des Infektionsrisikos. In der aktuellen Arbeit werden die kürzlich beschriebenen „reactive infectious mucocutaneous eruptions“ (RIME) und das „pediatric inflammatory multisystem syndrome“ (PIMS) vorgestellt. Zusätzlich werden wir einige atypische Manifestationen des Gianotti-Crosti-Syndroms und der Hand-Fuß-Mund-Erkrankung – wie z. B. die mit Mollusken assoziierte „Gianotti-Crosti-like reaction“ und das „eczema coxsackium“ – erläutern.

P398 A CASE OF MIS–C: SARS–COV2 AND MYOCARDITIS IN PEDIATRIC AGE

Abstract A 12–year–old patient with paucisymptomatic SARS–COV2 infection in November 2020 with negative swab after 10 days. After 3 weeks access to pediatric emergency room for fever, maculo–papular rash on the trunk, conjunctivitis, nausea and abdominal pain: evidence of thrombocytopenia, increased CPK, LDH, AST and inflammation markers. She starts antibiotic therapy for suspected sepsis. After 24 hours asthenia, general illness, hypotension and tachycardia: echocardium with diffuse hypokinesia of the left ventricle (EF 35%); worsening of thrombocytopenia, D–Dimer, BNP and CPK increase, hyponatremia, troponin positivity, ATIII reduction; negative viral markers. On the basis of the most recent literature, the diagnosis of MIS–C is made, a post–infection SARS–COV2 multisystemic inflammatory syndrome. After discussion with the 3rd level SARS–COV2 Pediatric Center, the following therapy begins: iv diuretic, iv cortisone, sc heparin, iv immunoglobulins, Anakinra. For a progressive clinical worsening by cardiogenic shock with evolution to DIC, she is transferred by military plane to the pediatric intensive care of 3rd level SARS–COV2 Center. The patient is subjected to mechanical ventilation, therapy with inotropes (adrenaline and milrinone) and CRRT ultrafiltration in order to reduce the excessive levels of inflammatory mediators responsible for rapid multiorgan failure. After 4 days, haemodynamic parameters improvement (EF 50%); sartan and low dose diuretic have been started because of the presence of diastolic dysfunction. Discharge after 1 month of hospitalization with good clinical and haemodynamic stability. After 6 months from myocarditis onset with cardiogenic shock in MIS–C, cardiac MRI with evidence of EF 57% and small area of delayed enhancement on the anterior IVS with non–ischemic pattern, no longer present by imaging after 1 year by acute event. Currently the patient reports subjective well–being by the regular follow–up without arrhythmias by Holter monitoring. SARS–COV2 post–infection multisystemic inflammatory syndrome (MIS–C) represents a serious complication with possible myocardial involvement also following a paucysymptomatic infection as in the described case. What happened shows us that SARS–COV2 infection is still a devious clinical entity that needs close follow–up in the short and long term.

The common triggers of urticaria in children admitted to the pediatric emergency room.

Urticaria frequently causes pediatric emergency department (PED) admissions. Children with urticaria may unnecessarily avoid suspected allergens. We aimed to investigate the possible and exact triggers of urticaria in children admitted to the PED. Medical records of children admitted to the PED within a 1-year period were evaluated for the International Classification of Diseases 10 (ICD-10) L50 urticaria code, noting symptoms, and possible triggers of urticaria. We performed telephone interviews to complete the missing data and further diagnostic tests for IgE-mediated allergies to identify the exact triggers of urticaria. Among 60,142 children, 462 (0.8%) with the L50 code were evaluated. Possible triggers based on the history and physical examination could be identified in 46%: infections (18%), drugs (11%), foods (8%), infections and drugs (3%), insects (3%), pollen (1%), blood products (0.4%), and vaccines (0.4%). The most frequent infections related to urticaria were upper respiratory tract infections (74.5%), urinary tract infections (13.2%), gastroenteritis (8.2%), and otitis media (4.1%). After a diagnostic workup, IgE-mediated allergic diseases were diagnosed in 6% of patients. Twenty-two percent of the patients had multiple PED admission for the same urticaria flare. Urticaria severity was found to be the most important risk factor for readmissions to the PED (odds ratio: 3.86; 95% confidence interval: 2.39-6.23; p < .001). No relationship between urticaria severity, duration, and the triggers was present. Despite detailed diagnostic tests, IgE-mediated allergic triggers were rarely the cause of urticaria in children admitted to the PED. Infections are the most frequent trigger. Severe urticaria causes more frequent readmissions to the PED.

An Uncommon Association of Ebstein’s Anomaly and Acute Rhumatic Fever

Background: Ebstein’s anomaly is a relatively rare congenital heart disease (atrialisation of the right ventricle). Anomalies of left side of the heart have been described with this condition. We however present a case of Ebstein's anomaly with recurrent acute rheumatic fever (ARF) and mitral stenosis. Case report: A 13-year-old boy with not followed for heart disease and with a history of notion of repetitive angina, is admitted to the pediatric emergency room for fever and polyarthritis. General examination not showed subcutaneous nodules and laboratory investigations revealed leucocytosis, elevated erythrocyte sedimentation rate (ESR) and antistreptolysin O (ASO) titre. Echocardiography revealed Ebstein anomaly with moderate mitral stenosis. A diagnosis of recurrent ARF was made based on the carditis, arthritis, history of recurrence of sore throat and evidence of recent streptococcal infection. He was transferred to the cardiology department and initially put on medical treatment. Its clinical course was marked by the appearance of unresolved ventricular tachycardia despite drug cardioversion. His prognosis was unfavorable with death after 10 days of hospitalization under antiarrhythmic treatment. Conclusion: Ebstein's disease is a rare disease. Cardiac arrhythmias are deleterious and the association of rheumatic fever with co-morbidity increases its lethality.

Retrospective study comparing success rates of lumbar puncture positions in infants

BackgroundA lumbar puncture (LP) is performed in the emergency room for diagnostic purposes; unsuccessful or traumatic LPs can complicate decision making. The sitting position has a larger interspinous process compared to lateral recumbent and is safer in sick neonates at risk for cardiac and respiratory instability. PurposeOur study aims to determine which position (lateral recumbent or sitting) is associated with a greater likelihood of successful lumbar puncture in infants <3 months when performed in the emergency room. Basic proceduresThis is a retrospective chart review in infants aged <3 months who had a LP performed in a pediatric emergency room. The primary outcome was the rate of successful LPs, defined as obtaining adequate CSF to send for all studies. The secondary outcome was the proportion of atraumatic LPs by position, defined as <500 RBCs or < 10,000 RBCs. Main findingsA total of 557 charts were reviewed with 116 in the sitting position and 441 in the lateral recumbent position. The primary outcome of adequate CSF fluid collection was not significantly different between groups (63% sitting position versus 58% lateral recumbent position; p = 0.22). In addition, the proportion of atraumatic LPs showed no significant difference regardless of RBC cutoff (<500 RBCs p = 0.83, <10,000 RBCs p = 0.60). Principle conclusionsThis study found no evidence that there is a difference in rate of LP success nor the proportion of traumatic LP in infants less than 3 months of age when positioned in the sitting position compared to the lateral recumbent position.

Delirium due to Anticholinergic Intoxication and Use of Physostigmine in Pediatric Emergency Room

Delirium due to Anticholinergic Intoxication and Use of Physostigmine in Pediatric Emergency Room

The Effect of a Structured Gastroenteritis Discharge Management Plan on Compliance, Prognosis, and Parents' Satisfaction.

Background: Acute gastroenteritis is one of the most common causes of dehydration in children. Parents’ education is an essential part of its management. In this study, we assessed the efficacy of discharge instructions in the pediatric emergency department for parents of children with acute gastroenteritis, together with disease prognosis and parents’ satisfaction.Methods: An observational prospective cohort study was conducted among parents of children with acute gastroenteritis, with mild-to-moderate dehydration, who presented to the pediatric emergency room from March 2018 to July 2018. Parents were interviewed upon their child’s presentation and in follow-up phone calls after one week to assess the parents’ knowledge and the disease’s prognosis.Results: There were a total of 218 parents of children with acute gastroenteritis of mild and moderate dehydration. The mean age was four years and one month ± three years and seven months. Forty-four percent of study participants had reasonable awareness of their child’s condition, and most patients (86%) improved fully. The exact adherence to instructions was 54%, the proportion of children who returned to the emergency department was 13%, and parental satisfaction and appreciation of the provided education was 98%.Conclusion: In the study group, not strictly following fluid rehydration plans in discharge instructions did not negatively affect the course of improvement. This indicates that simple instructions to rehydrate with any fluid a child might accept and give clear red flags for observation are likely to be enough to treat gastroenteritis of mild-to-moderate severity.

194. Patients with Somatic Symptoms and Related Disorders (SSRD) in a Tertiary Care Pediatric Hospital Center: The Need for a Structured Approach to Limit the COVID-19 Pandemics’ Impacts on Medical Care

During Covid-19 pandemics, a drop of 39% of all visits was observed through all Quebec pediatric emergency rooms for adolescents from 12 to 17 years old. Meanwhile, consultation for mental health problems showed a rise after waves 1 and 2. Adolescents were heavily impacted by the pandemic, SSRD being one expression of their difficulties. In 2019, a need for a dedicated clinic for somatisation was recognized through a survey in our Pediatric University Center. SSRD were identified in most specialities.

835 The Use of In-patient Concussion Consultation for Patient Education as a Model for Anticipatory Guidance in a Cohort of Pediatric Patients to Improve Symptom Score and Associated Health Outcomes

INTRODUCTION: It is estimated that 10% of all pediatric emergency room visits are due to concussions, and although most children recover without complications, problems including physical, emotional, somatic symptoms and sleep disturbances may occur. Pediatric populations are especially sensitive to these damaging sequelae as the plasticity of the developing neural networks of children are highly dynamic. It is with these considerations we have decided to undertake this study to evaluate if early in-patient concussion consultation in patients who have suffered traumatic brain injury (TBI) decreases recovery time, increases symptom reduction, and improves recovery to baseline neurocognitive functioning. METHODS: The patient cohort consisted of an initial 74 patients who were an in-patient concussion consultation using the acute concussion evaluation (ACE) tool to assess symptom score [0-22]. Patient files were queried for demographic information, comorbidities, and covariates of interest. The primary endpoints are clinical follow-up and reduction in symptom score between initial evaluation and clinical follow-up. All statistical analysis was performed using a significance level of α = 0.05. RESULTS: Delta score as a primary outcome was assessed only on patients retained during clinical follow-up. The difference in initial consult score compared to score at clinical follow-up was significant, p &lt; 0.001, with means of 12.125, and 3.889 respectively. Delta score was found to have resulted in a mean 8.289 reduction in symptom score, and a positive correlation was observed between initial symptom score and delta score. The results for linear and logistic regression of covariates will be presented during CNS 2021. CONCLUSIONS: The use of an in-patient concussion consultation provides families with an invaluable tool regarding education and management of concussion symptoms. Our initial results verify this modality of early intervention as an important tool to educate and highlight the importance of early engagement in increasing clinical retention and reducing concussive symptoms in this sensitive patient population.

Do healthcare disparities play a role in pediatric testicular torsion? – Analysis of a single large pediatric center

Healthcare disparities have been shown to impact outcomes of various acute pediatric conditions. We sought to examine the impact of race, ethnicity and insurance status on the presentation, management and outcome of testicular torsion. A retrospective review of a prospectively maintained testicular torsion database was performed. Patients ≤18 years of age evaluated in our pediatric institution's emergency room between April 2016-April 2020 with US diagnosed and OR confirmed testicular torsion were included. Basic demographics, timing of presentation, referral rate, time to OR and orchiectomy rate were extracted and compared. P<0.05 was considered statistically significant. A total of 206 patients were included. 114 (56.2%) were Black or African American (Black/AA), 43 were (21.2%) Hispanic/Latino, 22 (10.8%) were Caucasian, and 24 (11.8%) were designated as Other races. Ninety-eight (48.3%) patients had Medicaid, 90 (44.3%) had private insurance, and 15 (7.4%) patients were uninsured. Sixty-eight (33.0%) presented in a delayed fashion (>24h). Compared to the Caucasian patients, Black/AA patients were 2.1 years (95% CI: 0.5, 3.8; P=0.010) older at the time of presentation. When compared to those with Medicaid insurance, uninsured patients had 6.26 times (95% CI: 1.58, 41.88; P=0.021) higher odds to be referred from an outside hospital for management. In those patients presenting acutely (<24h, N=138), there were no significant differences in the odds of orchiectomy for Black/AA or Hispanic/Latino patients when compared to Caucasian patients, however, the odds of orchiectomy in Other races (non-Caucasian, non-Black/AA, non-Hispanic/Latino) was significantly higher (OR: 10.38; 95% CI: 1.13, 246.96; P=0.049). While the mean time in minutes from ED to OR was longer in those with Medicaid insurance (141 vs 125.4 private vs 115 uninsured, p=0.042), this did not impact orchiectomy rate (39.8% vs 40.9% vs 46.7%, p=0.88). We found no differences in the orchiectomy rates by race with the exception of a higher rate in the diverse and heterogeneous Other race (non-Caucasian, non-Black/AA, non-Hispanic/Latino) group. Those uninsured had a higher referral rate highlighting the potential existence of disparities for those uninsured and the need for further investigation.

Mortality pattern within twenty-four hours of admission to a pediatric emergency room in a teaching hospital in Ghana

BackgroundChildhood mortality in sub-Saharan Africa still remains high despite a reduction in global trends. Although several strategies have been instituted to help reduce this, the progress is slow which can affect the achievement of the Sustainable Development Goal 3 (SDG). Majority of these deaths occur within the first twenty-four hours of admission due to delay in seeking medical care and inability to identify and adequately resuscitate the critically ill patients. The aim of the study was to describe the pattern of mortality within the first twenty-four hours in children presenting to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana.&#x0D; Methods&#x0D; This was a retrospective review of mortalities in children aged 2 months to 13 years admitted to PEU from January to December 2020. The bio-data, duration of illness, diagnoses, duration of hospital stay and admission outcome were extracted from their health records and analysed.&#x0D; Results&#x0D; There were 2,145 admissions during the study period of which 59.3% (n=1272) were males, and 38.5% (n=825) were under-five years of age. Out of the 171 (7.9%) that died, 31.5% (n=54) occurred during the first 24 hours with 51.8% (n=28) being males and 77.7% (n=42) under-five years of age.&#x0D; The months with the highest recorded mortality occurring within 24 hours were January 16.6% (n=9), March 14.8% (n=8), and February 12.9% (n=7) with sepsis/septic shock 18.5% (n=10), Pneumonia 12.9% (n=7), surgical conditions 9% (n=5), Severe acute malnutrition 7% (n=4), and diarrhoea diseases 7% (n=4) being the leading causes of death.&#x0D; Conclusion&#x0D; Sepsis/septic shock and pneumonia are top two causes of mortality within 24-hours of admission with the highest mortality occurring in the first quarter. In order to end preventable deaths in under-fives and achieve the SDG 3.2, early health care seeking behaviour, quality and timely interventions for critically ill children as well as appropriate development and deployment of disease commodity packages will be key.

The prevalence of abnormal brain CT scans in pediatrics emergency department: two years single-center retrospective chart review study

Background: Traumatic head injury represents a substantial cause of trauma in pediatric emergency rooms (ER). This study aimed to calculate the prevalence of abnormal computed tomography (CT) scan reports (CT) in the pediatric ER at King Abdullah Specialized Children\&amp;apos;s Hospital (KASCH) in Riyadh. In addition, it examined different variables that are more likely associated with a normal CT scan. Methods: This single-center retrospective chart review study was conducted using nonprobability convenience sampling; data were collected from the electronic health records of ER pediatric patients. Patients aged 0 to 14 years, who had a trauma and a brain CT scan ordered in KASCH ER, from May 2017 to May 2019 were included. Results: In total, 502 CT scans were done due to a traumatic head-related event. About a third (34.5%, n = 173) had an abnormal CT scan, with the majority of the group (69.4%, n = 120) being male. The highest rate of abnormal CT scans (28.9%) was in the 2-5 years age group. The most common mechanism of injury was falling (55%), followed by motor vehicle accidents (33.5%). Falling, as a mechanism of injury, accounted for more than half of the injuries in both the normal (57.1%) and abnormal (50.9%) CT scans. Conclusion: Two-thirds of the head CT included in this study resulted in normal CT findings and a considerable number of the abnormal findings were linear non-displaced fractures that can be detected by X-ray.

Effects of the new fasting standard on sedation in the pediatric emergency room.

This study compared adherence to the fasting-time guidelines of the International Committee for the Advancement of Procedural Sedation (ICAPS) and the North American Society of Anesthesiologists (ASA) and complication rates in pediatric patients requiring procedure sedation and analgesia during treatment in the emergency room (ER). This retrospective, single-center study was performed between 2016 and 2020, and enrolled patients who received procedural sedation and analgesia in the ER with the fasting times recommended in the ICAPS and ASA guidelines. In total, 857 patients were included. The most frequent indication for procedural sedation and analgesia was fracture reduction in 420 patients (49.0%). Ketamine, the most commonly administered drug, was given to 710 patients (82.8%). Adherence to the ICAPS guidelines was higher (P < 0.01), with 772 (95.7%) and 351 (41.0%) patients, respectively, adhering to the ICAPS and ASA recommendations for food and drink fasting times. Complications occurred in 130 patients (15.2%), including SpO2 <90% in 75 patients (8.7%) and vomiting in 20 patients (2.3%). No serious complications, such as aspiration, cardiac arrest, or death, occurred. The complication rate between the two groups did not differ significantly, with 50 (14.2%) and 127 (15.5%) patients experiencing complications according to the ICAPS and ASA guidelines, respectively (P = 0.586). The fasting recommendations of the ICAPS guidelines, which propose risk stratification to determine the appropriate fasting time for procedural sedation and analgesia, are more tolerable to patients and the rate of adverse events did not appear to be different from that experienced when following the ASA guidelines.

Emergency brain imaging findings in children with first afebril convulsion

Convulsion is the most common neurological disease seen in childhood and constitutes 4-10% of all neurological diseases and 2% of the admissions to child emergency rooms. While the primary purpose of performing emergency neuroimaging in a child presenting with the first afebrile convulsion is to investigate intracranial pathologies that may require urgent intervention. The cranial imaging to be performed for this purpose are transfontanellar ultrasonography, computed tomography, and magnetic resonance imaging. We aimed to evaluate the necessity, the contribution to diagnosis, and the effect of treatment of magnetic resonance imaging that was performed in the emergency rooms. Patients who were admitted to the pediatric emergency room for a one-year complaint of their first afebrile convulsion and performed brain magnetic resonance imaging in the pediatric emergency room within the first 24 hours of hospital admission were evaluated retrospectively. A statistically significant correlation was found between the abnormal magnetic resonance imaging and abnormal physical examination of the patients (p&lt;0.001). By the brain magnetic resonance imaging findings acute changes were made in the treatment of 7 cases (1.3%) There was no statistically significant relationship between the magnetic resonance imaging abnormality and emergency seizures. We determined that it would be more appropriate to perform magnetic resonance imaging in outpatient clinics in cases where transportation can be provided early, in cases above 6 years of age without risk factors, and have a normal examination. Nonetheless, higher magnetic resonance imaging rates lead to lower computed tomography rates and ıts beneficial for pediatric patients in limiting radiation and providing definitive structural imaging for seizures.

Readmission of late preterm and term neonates in the neonatal period

ObjectiveTo determine the incidence of hospital readmissions in late preterm and term neonates, the most common reasons for readmission, and analyze the risk factors for readmission in the neonatal period. MethodsNewborn infants admitted to a well-baby nursery ≥ 36 weeks gestation were included in this retrospective cohort study. Data for all infants born in a 3-year period and readmitted in the first 28 days of life were analyzed. Indication for readmission was one diagnosed during initial workup in the pediatric emergency room visit before readmission. ResultsThe final cohort consisted of 5408 infants. The readmission rate was 4.0% (219/5408). Leading readmission causes were respiratory tract infection (29.58%), jaundice (13.70%), and urinary tract infection (9.59%). The mean ± SD age of readmitted infants was 13.3 ± 7.1 days. The mean ± SD treatment duration of treatment was 5.5 ± 3.0 days. In the multivariate regression analysis, infants that were during the initial hospitalization transferred to special care/NICU had a lower chance of readmission during the neonatal period (p = 0.04, OR = 0.23, 95% CI 0.06–0.93). Infants with mothers aged from 19–24 years had a higher risk of readmission (p = 0.005, OR = 1.62, 95% CI 1.16–2.26). ConclusionsFinding that infants that were during the initial hospitalization transferred to special care or a NICU setting were less likely to require hospitalization in the neonatal period is an interesting one. Further research into how different approach in these settings reduce the risk of readmission is necessary.

Lyell Syndrome in the Pediatric Emergency Room of the University Hospital Center (UHC) Gabriel Toure

<i>Introduction:</i> Toxic epidermal necrolysis (TEN) or Lyell syndrome is the most severe form of toxidermia. It is clinically characterised by a generalised exanthema with a skin detachment of more than 30% of the body surface area, which differentiates it from Stevens-Johnson syndrome (SJS), which affects less than 10% of the body surface area. Its management is essentially symptomatic. The aim of our study is to investigate the clinical, therapeutic and evolutionary aspects of Lyell syndrome. Materials and <i>Method: </i>We conducted a retrospective prospective cross-sectional and descriptive study over a period of 5 years (from 1 January 2014 to 31 December 2018). It concerned children from 1 month to 15 years old. Data were collected using a pre-established survey form and inpatient records. After informed consent from parents and the Head of Department, all information was collected in strict confidentiality.<i> Results:</i> During the study period, we were able to collect 10 patients meeting our inclusion criteria out of 9050 hospitalizations, or a frequency of 0.11%. The sex ratio was 4. The age group (6 months to 5 years) was the most affected with 60% of cases. Almost all patients (90%) consulted for skin lesions. The drugs frequently incriminated were non-steroidal anti-inflammatory drugs and anti-epileptics in equal proportions (20%). In 4 patients (40%), no drug could be clearly incriminated. On physical examination, NIKOLSKI's sign was found in 90% of patients. Management was essentially based on rehydration, antibiotic therapy, analgesics and local care. However, mortality remains very high (7 out of 10 patients). <i>Conclusion: </i>A rare but very serious pathology, Lyell syndrome has a poor prognosis in our context.

Epidemiological and Clinical Aspects of Acute Intoxications in Children Between 1 Month and 15 Years in the Paediatric Emergency of the UHC Gabriel Toure

<i>Introduction:</i> Defined by the WHO as all the pathological manifestations following ingestion of food or the administration of products or drugs behaving like a poison in the body, acute intoxication is a growing problem. serious in pediatrics, in developing countries because of their frequency and the difficulties of care. In Mali, poisoning in children is very poorly assessed, in part due to the lack of popularization of poison control and pharmacovigilance centers. The objective of our study is to study the epidemiological and clinical aspects of acute poisoning in children in the emergency department of the pediatric department of the Gabriel Touré University Hospital. <i>Material and methods:</i> We carried out a retrospective, cross-sectional and descriptive study from January 2016 to December 2018, or a period of 3 years. It concerned children from 1 month to 15 years old hospitalized in the pediatric emergency room of the Gabriel Touré University Hospital for proven acute poisoning. The data were collected by: a pre-established individual survey form, information contained in the medical files of patients after the approval of the Head of the Department. <i>Results:</i> During our study period, 80 children were hospitalized for acute poisoning out of a total of 5,437, a frequency of 1.47%. The sex ratio was 1.3. The 13-48-month age group accounted for 65% of cases. The patients themselves were responsible for their poisoning in 74.2% of cases. Poisoning by unspecified drugs accounted for 25% of cases. The oral route represented 92.4% of the poisoning routes. Ingestion of milk (29.9%) and oil (6.3%) were the most common actions for parents. Vomiting with 35% and respiratory distress with 35% were the most frequent manifestations. The mean hospital stay was 3.5 days (50%). In 50% of cases, death occurred within the first 24 hours. <i>Conclusion:</i> Poisoning remains a common occurrence in our department, mainly linked to several medicines and household products.

PRIMARY MENINGOCOCCAL ARTHRITIS: A CASE REPORT

Neisseria meningitidis is a gram-negative diplococcus often associated with invasive infections such as meningitis and fulminant sepsis. primary meningococcal septic arthritis (PMSA) is extremely rare. Diagnosis should be prompt and is based on isolation of the germ from synovial fluid or blood culture. This observation reports the case of a 6 -year- old girl who presented to the pediatric emergency room with a painful right knee associated with fever and purpuric spots. The neurological examination was strictly normal with no signs of meningeal involvement. Arthrotomy and drainage were performed. The cytobacteriological examination of the synovial fluid allowed the isolation of a strain of N. meningitidis sensitive to ceftriaxone on culture media. Intravenous antibiotic therapy was then started. The patient improved after adequate treatment. Conclusion: This observation illustrates an unusual presentation of Neisseria meningitidis infections. Prompt bacteriological diagnosis and early treatment combining antibiotics and joint drainage prevented complications in this patient.