La récupération de l état de santé et le stress post-traumatique chez les enfants accidentés de la route (une étude de cohorte)

Cette thèse étudie les facteurs prédictifs et les facteurs associés à la récupération de l état de santé et au stress post-traumatique chez l enfant après un accident de la route. Il s agit d une étude de cohorte prospective mise en place en 2004 composée de 204 enfants de moins de 16 ans, hospitalisés dans les hôpitaux publiques et privés du département du Rhône à la suite d un accident de la route. Un an après l accident, parmi les 127 enfants évalués par questionnaires, 78 (75,0 %) enfants légèrement ou modérément blessés et 8 (34,8%) enfants gravement blessés estimaient avoir complétement récupéré leur état de santé. Après ajustement, le score de gravité (M-AIS>=3) et les lésions des membres inférieurs (AIS>1) étaient associés à la non récupération de l état de santé : Odds Ratio pondérés (ORw) respectifs de 4,3 [IC 95%, 1,3-14,6] et 6,5 [IC 95%, 1,9-21,7]. L état de récupération était significativement corrélé au score physique de la qualité de vie (r=0,46) et dans une moindre mesure au score psychosocial de qualité de vie (r=0,21). D importants symptômes de stress post-traumatique étaient présents chez 26 (27,7%) enfants un an après un accident de la route et cela indépendamment de la gravité des lésions initiales. Dans cette cohorte pédiatrique d accidentés de la route, les enfants ayant des lésions graves (M-AIS>=3) ou des lésions des membres inférieurs avaient une moins bonne récupération de l état de santé à un an. Un état de santé altéré était associé à une qualité de vie plus faible à un an. Il parait important de ne pas négliger les conséquences que peuvent avoir les accidents de la route sur la santé physique et psychique des enfants légèrement blessés.The aim of this thesis was to evaluate predictive factors of recovery and post-traumatic stress in children one year after road traffic injuries. This prospective cohort study was composed of 204 children aged =3) and lower limb injury (AIS>=2) were associated with no full recovery of health status: Weighted Odds Ratio (ORw) : 4.3 [95% Confidence Interval (95% CI) : 1.3-14.6] and ORw : 6.5 [95% CI : 1.9-21.7] respectively. The recovery status was significantly correlated to quality of life Physical scores (r=0.46) especially to Body Pain (r=0.48) and Role/Social physical (r=0.50) and to a lesser extent to quality of life Psychosocial scores (r=0.21). Important post-traumatic stress symptoms were present in 27.7% of children one year after a road traffic accident. In a cohort of children injured in a road accident, those with high injury severity score and those with lower limb injuries are more likely to not fully recover their health status at 1 year. Altered health status was associated with a lower physical quality of life score at 1 year. It seems important to consider psychological consequences road traffic accidents may have on children even after mild or moderate injuries.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Elevated monocyte HLA-DR in pediatric secondary hemophagocytic lymphohistiocytosis: a retrospective study

IntroductionHemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition, and its diagnosis may be challenging. In particular, some cases show close similarities to sepsis (fever, organ failure, and high ferritin), but their treatment, while urgent, differ: prompt broad-spectrum antibiotherapy for sepsis and immunosuppressive treatment for HLH. We questioned whether monocyte human leucocyte antigen (mHLA)–DR could be a diagnostic marker for secondary HLH (sHLH).MethodsWe retrospectively reviewed data from patients with a sHLH diagnosis and mHLA-DR quantification. mHLA-DR data from healthy children and children with septic shock, whose HLA-DR expression is reduced, from a previously published study were also included for comparison.ResultsSix patients with sHLH had mHLA-DR quantification. The median level of monocyte mHLA-DR expression in patients with sHLH [79,409 antibodies bound per cell (AB/C), interquartile range (IQR) (75,734–86,453)] was significantly higher than that in healthy children and those with septic shock (29,668 AB/C, IQR (24,335–39,199), and 7,493 AB/C, IQR (3,758–14,659), respectively). Each patient with sHLH had a mHLA-DR higher than our laboratory normal values. Four patients had a second mHLA-DR sampling 2 to 4 days after the initial analysis and treatment initiation with high-dose corticosteroids; for all patients, mHLA-DR decreased to within or close to the normal range. One patient with systemic juvenile idiopathic arthritis had repeated mHLA-DR measurements over a 200-day period during which she underwent four HLH episodes. mHLA-DR increased during relapses and normalized after treatment incrementation.ConclusionIn this small series, mHLA-DR was systematically elevated in patients with sHLH. Elevated mHLA-DR could contribute to sHLH diagnosis and help earlier distinction with septic shock

Enhance quality care performance: Determination of the variables for establishing a common database in French paediatric critical care units

Abstract Selected variables for the French Paediatric Intensive Care registry. Rationale, aims, and objectives Providing quality care requires follow-up in regard to clinical and economic activities. Over the past decade, medical databases and patient registries have expanded considerably, particularly in paediatric critical care medicine (eg, the Paediatric Intensive Care Audit Network (PICANet) in the UK, the Australian and New Zealand Paediatric Intensive Care (ANZPIC) Registry in Australia and New Zealand, and the Virtual Paediatric Intensive Care Unit Performance System (VPS) in the USA). Such a registry is not yet available in France. The aim of this study was to determine variables that ought to be included in a French paediatric critical care registry. Methods Variables, items, and subitems from 3 foreign registries and 2 French local databases were used. Items described each variable, and subitems described items. The Delphi method was used to evaluate and rate 65 variables, 90 items, and 17 subitems taking into account importance or relevance based on input from 28 French physicians affiliated with the French Paediatric Critical Care Group. Two ratings were used between January and May 2013. Results Fifteen files from 10 paediatric intensive care units were included. Out of 65 potential variables, 48 (74%) were considered to be indispensable, 16 (25%) were considered to be optional, and 1 (2%) was considered to be irrelevant. Out of 90 potential items, 62 (69%) were considered to be relevant, 23 (26%) were considered to be of little relevance, and 5 (6%) were considered to be irrelevant. Out of 17 potential subitems, 9 (53%) were considered to be relevant, 6 (35%) were considered to be of little relevance, and 2 (12%) were considered to be irrelevant. Conclusions The necessary variables that ought to be included in a French paediatric critical care registry were identified. The challenge now is to develop the French registry for paediatric intensive care units

Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC)

Purpose: Much of the common practice in paediatric mechanical ventilation is based on personal experiences and what paediatric critical care practitioners have adopted from adult and neonatal experience. This presents a barrier to planning and interpretation of clinical trials on the use of specific and targeted interventions. We aim to establish a European consensus guideline on mechanical ventilation of critically children. Methods: The European Society for Paediatric and Neonatal Intensive Care initiated a consensus conference of international European experts in paediatric mechanical ventilation to provide recommendations using the Research and Development/University of California, Los Angeles, appropriateness method. An electronic literature search in PubMed and EMBASE was performed using a combination of medical subject heading terms and text words related to mechanical ventilation and disease-specific terms. Results: The Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) consisted of a panel of 15 experts who developed and voted on 152 recommendations related to the following topics: (1) general recommendations, (2) monitoring, (3) targets of oxygenation and ventilation, (4) supportive measures, (5) weaning and extubation readiness, (6) normal lungs, (7) obstructive diseases, (8) restrictive diseases, (9) mixed diseases, (10) chronically ventilated patients, (11) cardiac patients and (12) lung hypoplasia syndromes. There were 142 (93.4%) recommendations with "strong agreement". The final iteration of the recommendations had none with equipoise or disagreement. Conclusions: These recommendations should help to harmonise the approach to paediatric mechanical ventilation and can be proposed as a standard-of-care applicable in daily clinical practice and clinical research

Autoantibodies against type I IFNs in patients with critical influenza pneumonia

In an international cohort of 279 patients with hypoxemic influenza pneumonia, we identified 13 patients (4.6%) with autoantibodies neutralizing IFN-alpha and/or -omega, which were previously reported to underlie 15% cases of life-threatening COVID-19 pneumonia and one third of severe adverse reactions to live-attenuated yellow fever vaccine. Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-alpha 2 alone (five patients) or with IFN-omega (eight patients) from a cohort of 279 patients (4.7%) aged 6-73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-alpha 2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-omega. The patients' autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients 70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-alpha 2 and IFN-omega (OR = 11.7, P = 1.3 x 10(-5)), especially those <70 yr old (OR = 139.9, P = 3.1 x 10(-10)). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for similar to 5% of cases of life-threatening influenza pneumonia in patients <70 yr old

Higher COVID-19 pneumonia risk associated with anti-IFN-α than with anti-IFN-ω auto-Abs in children

We found that 19 (10.4%) of 183 unvaccinated children hospitalized for COVID-19 pneumonia had autoantibodies (auto-Abs) neutralizing type I IFNs (IFN-alpha 2 in 10 patients: IFN-alpha 2 only in three, IFN-alpha 2 plus IFN-omega in five, and IFN-alpha 2, IFN-omega plus IFN-beta in two; IFN-omega only in nine patients). Seven children (3.8%) had Abs neutralizing at least 10 ng/ml of one IFN, whereas the other 12 (6.6%) had Abs neutralizing only 100 pg/ml. The auto-Abs neutralized both unglycosylated and glycosylated IFNs. We also detected auto-Abs neutralizing 100 pg/ml IFN-alpha 2 in 4 of 2,267 uninfected children (0.2%) and auto-Abs neutralizing IFN-omega in 45 children (2%). The odds ratios (ORs) for life-threatening COVID-19 pneumonia were, therefore, higher for auto-Abs neutralizing IFN-alpha 2 only (OR [95% CI] = 67.6 [5.7-9,196.6]) than for auto-Abs neutralizing IFN-. only (OR [95% CI] = 2.6 [1.2-5.3]). ORs were also higher for auto-Abs neutralizing high concentrations (OR [95% CI] = 12.9 [4.6-35.9]) than for those neutralizing low concentrations (OR [95% CI] = 5.5 [3.1-9.6]) of IFN-omega and/or IFN-alpha 2

La prise en charge des méningites bactériennes graves de l'enfant en 2016

Bacterial meningitis is a severe infection of the central nervous system with significant impact on survival and functional outcome. Complications are related to the release of bacterial components in the subarachnoid space closed to the brain. Three types of complications are distinguished: septic shock that alters the oxygen delivery, intracranial hypertension (ICH) that may alter the cerebral perfusion pressure and severe metabolic disorders like hyponatremia.Les méningites bactériennes sont des infections graves du système nerveux central mettant en jeu le pronostic vital et fonctionnel. Les complications sont liées à l'inflammation générée par la libération des substances bactériennes dans l'espace méningé au contact du cerveau. Les complications sont de trois types : le choc infectieux qui altère la délivrance d'oxygène aux tissus, une hypertension intracrânienne (HTIC) qui peut altérer la perfusion cérébrale et des troubles métaboliques tels que l'hyponatrémie

La prise en charge des méningites bactériennes graves de l'enfant en 2016

Bacterial meningitis is a severe infection of the central nervous system with significant impact on survival and functional outcome. Complications are related to the release of bacterial components in the subarachnoid space closed to the brain. Three types of complications are distinguished: septic shock that alters the oxygen delivery, intracranial hypertension (ICH) that may alter the cerebral perfusion pressure and severe metabolic disorders like hyponatremia.Les méningites bactériennes sont des infections graves du système nerveux central mettant en jeu le pronostic vital et fonctionnel. Les complications sont liées à l'inflammation générée par la libération des substances bactériennes dans l'espace méningé au contact du cerveau. Les complications sont de trois types : le choc infectieux qui altère la délivrance d'oxygène aux tissus, une hypertension intracrânienne (HTIC) qui peut altérer la perfusion cérébrale et des troubles métaboliques tels que l'hyponatrémie

Epidémiologie des décès pédiatriques intra-hospitaliers de 2005 à 2012 et évolution des urgences vitales intra-hospitalières après ouverture de l'hôpital femme mère enfant

LYON1-BU Santé (693882101) / SudocSudocFranceF