La maladie de Rendu-Osler-Weber (à propos d'une observation pédiatrique et revue de la littérature)

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Etude d une population de nourrissons de moins de deux mois hospitalisés pour bronchiolite à VRS dans le service de pédiatrie d Antoine Béclère sur trois hivers consécutifs (pertinence de l âge comme critère d hospitalisation)

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

LE SYNDROME DE PEUTZ-JEGHERS (A PROPOS D'UN CAS REVELE PAR UNE ANEMIE AIGUE ET REVUE DE LA LITTERATURE)

PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge de la pyélonéphrite aigüe de l'enfant (étude rétrospective sur 197 cas et revue de la littérature)

PARIS7-Villemin (751102101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Clinical predictors of radiographic abnormalities among infants with bronchiolitis in a paediatric emergency department

International audienceBackgroundAcute viral respiratory exacerbation is one of the most common conditions encountered in a paediatric emergency department (PED) during winter months. We aimed at defining clinical predictors of chest radiography prescription and radiographic abnormalities, among infants with bronchiolitis in a paediatric emergency department.MethodsWe conducted a prospective cohort study of children less than 2 years of age with clinical bronchiolitis, who presented for evaluation at the paediatric emergency department of an urban general hospital in France. Detailed information regarding historical features, examination findings, and management were collected. Clinical predictors of interest were explored in multivariate logistic regression models.ResultsAmong 410 chest radiographs blindly interpreted by two experts, 40 (9.7%) were considered as abnormal. Clinical predictors of chest radiography achievement were age (under three months), feeding difficulties, fever over 38°C, hypoxia under than 95% of oxygen saturation, respiratory distress, crackles, and bronchitis rales. Clinical predictors of radiographic abnormalities were fever and close to significance hypoxia and conjunctivitis.ConclusionOur study provides arguments for reducing chest radiographs in infants with bronchiolitis. For infants with clinical factors such as age less than three months, feeding difficulties, respiratory distress without hypoxia, isolated crackles or bronchitis rales, careful clinical follow-up should be provided instead of chest radiography

Age-related respiratory rate, from Liu et al. [10].

<p>Age-related respiratory rate, from Liu et al. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0096189#pone.0096189-Liu1" target="_blank">[10]</a>.</p

Demographics of the study population (<i>n</i> = 697).

<p>Demographics of the study population (<i>n</i> = 697).</p

Effect of chest radiography on antibiotic use.

<p>Effect of chest radiography on antibiotic use.</p

Impact of Chest Radiography for Children with Lower Respiratory Tract Infection: A Propensity Score Approach

International audienceBackgroundManagement of acute respiratory tract infection varies substantially despite this being a condition frequently encountered in pediatric emergency departments. Previous studies have suggested that the use of antibiotics was higher when chest radiography was performed. However none of these analyses had considered the inherent indication bias of observational studies.ObjectiveThe aim of this work was to assess the relationship between performing chest radiography and prescribing antibiotics using a propensity score analysis to address the indication bias due to non-random radiography assignment.MethodsWe conducted a prospective study of 697 children younger than 2 years of age who presented during the winter months of 2006–2007 for suspicion of respiratory tract infection at the Pediatric Emergency Department of an urban general hospital in France (Paris suburb). We first determined the individual propensity score (probability of having a chest radiography according to baseline characteristics). Then we assessed the relation between radiography and antibiotic prescription using two methods: adjustment and matching on the propensity score.ResultsWe found that performing a chest radiography lead to more frequent antibiotic prescription that may be expressed as OR = 2.3, CI [1.3–4.1], or as an increased use of antibiotics of 18.6% [0.08–0.29] in the group undergoing chest radiography.ConclusionChest radiography has a significant impact on the management of infants admitted for suspicion of respiratory tract infection in a pediatric emergency department and may lead to unnecessary administration of antibiotics