Objetivo : Identificar os fatores determinantes de lesões não intencionais na população pediátrica residente na comunidade de Paraisópolis, em São Paulo. Métodos : Estudo transversal, não controlado. Os dados coletados durante 4 meses consecutivos, por meio de questionários preenchidos para o Programa Einstein na Comunidade de Paraisópolis foram: identificação do paciente e familiares, escolaridade, condições da moradia, armazenamento de produtos perigosos, acesso à rua e à laje, supervisão e mecanismo de trauma envolvido. Os dados observados foram tratados por meio de frequências absolutas e relativas; foram empregados os testes χ2, exato de Fisher, t de Student Mann-Whitney, com nível de significância de 5% (p<0,05). Resultados : Foram analisados 1.490 questionários. Houve predominância de traumatismos entre meninos (59,6%) e a média de idade foi de 5,2 anos. Ensino Fundamental incompleto foi o nível de escolaridade predominante entre os pais. O cuidador principal identificado foi a mãe (69,4%). Das crianças que sofreram trauma, 56,4% pertenciam a famílias numerosas (≥6 pessoas), moravam em casas de até três cômodos com renda familiar de até R$ 1.000,00 (76,6%). O acesso fácil a substâncias perigosas foi considerável, e o livre acesso a lajes foi relatado em 92,8% dos casos. Os principais mecanismos de trauma foram quedas e queimaduras. Neste estudo, a criança vítima de queda tinha menos de 5 anos de idade. Conclusão : Crianças pequenas que vivem em um ambiente de risco apresentam tendência significativa a sofrer eventos traumáticos.

Objective : To identify the factors that determine unintentional injuries in children living in the community of Paraisopolis, in the city of São Paulo, Brazil. Methods : A cross-sectional and non-controlled study. Data collected during 4 consecutive months through questionnaires filled out for the Einstein Program in Paraisopolis Community included identification of the patient and his/her family, scholarity level, housing conditions, storage of hazardous products, access to the streets and concrete slab ceilings, supervision, and trauma mechanism involved. The observed data were treated as absolute and relative frequencies; χ2, Fisher’s exact test, Student’s t test, and Mann-Whitney’s tests were implemented, with a significance level of 5% (p<0.05). Results : A total of 1,490 questionnaires were analyzed. There was a predominance of trauma within boys (59.6%) and the medium age was 5.2 years. The predominant educational level of the parents was incomplete junior school education. The main caregiver identified was the mother (69.4%). Among the children that suffered trauma, 56.4% belonged to large families (≥6 people), lived in houses up to three rooms, and a family income up to R$ 1,000.00 (76.6%). Easy access to hazardous materials was considerable and free access to concrete slab ceilings was reported in 92.8% of the cases. The main trauma mechanisms were falls and burns. In this study, the child victim of a fall was aged under 5 years. Conclusion : Small children that live in a hazardous environment have a significant tendency to suffering trauma

OBJETIVO: Traçar o perfil epidemiológico de pacientes admitidos no Centro de Terapia Intensiva Pediátrico do Hospital Israelita Albert Einstein no período de 1 ano. MÉTODOS: Os dados foram coletados retrospectivamente de todos pacientes admitidos no Centro de Terapia Intensiva Pediátrico durante o ano de 2009. A extração dos dados contidos nos 433 prontuários revisados foi realizada do sistema DATAMARTS e analisada com o programa estatístico STATA, versão 11. RESULTADOS: Não houve diferença significativa para gênero, e a faixa etária predominante foi de 1 a 4 anos. A média de ocupação foi de 69,3% ao ano com maior fluxo nos meses de abril, agosto e outubro. A média de permanência variou de 9,7 a 19,1 dias. As doenças respiratórias foram responsáveis pelo maior número de pacientes no Centro de Terapia Intensiva Pediátrico e a taxa de mortalidade foi de 1,85%. CONCLUSÕES: As doenças respiratórias foram as mais frequentes e a maior taxa de mortalidade esteve associada a doenças neoplásicas.

OBJECTIVE: This study outlined the epidemiological profiles of patients who were admitted to the Pediatric Intensive Care Center at Albert Einstein Israelite Hospital during 2009. METHODS: Data were retrospectively collected for all patients admitted to the PICC during 2009. A total of 433 medical charts were reviewed, and these data were extracted using the DATAMARTS System and analyzed using the statistical software package STATA, version 11.0. RESULTS: There were no statistically significant differences in regards to patient gender, and the predominant age group consisted of patients between the ages of 1 to 4 years. The average occupancy rate was 69.3% per year, and there was a greater number of admissions during April, August, and October. The average length of stay at the hospital ranged from 9.7 to 19.1 days. Respiratory diseases were the main cause for admission to the Pediatric Intensive Care Center, and the mortality rate of the patients admitted was 1.85%. CONCLUSIONS: Respiratory diseases were the most common ailment among patients admitted to the Pediatric Intensive Care Center, and the highest mortality rates were associated with neoplastic diseases.

OBJECTIVES: To determine the viruses and risk factors associated with hospital and intensive care unit (ICU) admissions in infants with acute bronchiolitis. INTRODUCTION: Bronchiolitis is a major cause of morbidity in infants. Widespread use of molecular-based methods has yielded new insights about its etiology, but the impact of viral etiologies on early outcomes is still unclear. METHODS: Seventy-seven infants with bronchiolitis who were under two years of age and visited an emergency unit were included. Using molecular-based methods, samples were tested for 12 different respiratory viruses. Logistic regression models were used to identify clinical and virological variables associated with the main endpoints: hospital admission and ICU admission. RESULTS: We identified at least one virus in 93.5% of patients, and coinfections were found in nearly 40% of patients. RSV was the most common pathogen (63.6%), followed by rhinovirus (39%). Identification of RSV was only associated with an increased risk of hospital admission in the univariate model. Younger age and enterovirus infection were associated with an increased risk of hospital admission, while atopy of a first-degree relative showed a protective effect. Prematurity was associated with an increased risk of admission to the ICU. Coinfections were not associated with worse outcomes. CONCLUSIONS: Molecular-based methods resulted in high rates of viral identification but did not change the significant role of RSV in acute bronchiolitis. Younger age and enterovirus infection were risk factors for hospital admission, while prematurity appeared to be a significant risk factor for admission to the ICU in acute viral bronchiolitis.

OBJETIVO: Devido ao impacto determinado pelo trauma na população infanto-juvenil no que diz respeito à mortalidade, morbidade e conseqüências sociais geradas, nossos objetivos concentram-se nas peculiaridades da avaliação pré-hospitalar, em ambiente hospitalar e ainda durante o transporte do paciente traumatizado pediátrico. FONTES DE DADOS: Pesquisa eletrônica realizada nas bases Cochrane para revisões sistemáticas e estudos controlados, MEDLINE e LILACS nos últimos 5 anos e revisão de referências anteriores em publicações significativas, utilizando as seguintes palavras-chave: trauma, trauma pediátrico, exame primário, exame secundário, atendimento hospitalar, transporte pré-hospitalar e inter-hospitalar. SÍNTESE DOS DADOS: Diferentes estratégias compõem a sistematização do atendimento de crianças e adolescentes traumatizados. Entretanto, quase todas comportam a necessidade de conhecer as particularidades da população a ser tratada, no que diz respeito à idade, ao processo de crescimento e desenvolvimento e, finalmente, compondo o atendimento com os recursos minimamente aceitáveis e disponíveis. CONCLUSÕES: O princípio de maior importância diz respeito a não determinar lesão adicional. Mantendo a visão sistemática das diferentes peculiaridades quanto à abordagem das vias aéreas, ventilação, circulação com controle de hemorragias, exame minineurológico e exposição, além do exame secundário, com o preparo do transporte pré-hospitalar e inter-hospitalar quando necessário, serão esperados melhores resultados.

OBJECTIVES: Since trauma has a great impact on mortality and preventable morbidity among children and adolescents, in addition to its social consequences, the aim of this study is to evaluate peculiarities regarding prehospital, in-hospital, and interhospital assessment of injured pediatric patients. SOURCES OF DATA: The Cochrane database was searched for systematic reviews and controlled trials, the MEDLINE and LILACS databases were used for the last 5 years, and review of older reference sections in significant publications using trauma, pediatric trauma, primary survey, secondary survey, in-hospital assessment, prehospital and transportation as keywords. SUMMARY OF THE FINDINGS: There are different strategies that constitute the systematic assessment of the injured pediatric patient. Nevertheless, almost all strategies involve knowing the peculiarities about the pediatric population, with regard to age, to the growth and development process, and finally, to the minimally acceptable and available resources. CONCLUSIONS: The most important principle is to do no further harm. If the peculiarities about airway maintenance, ventilation, circulation with hemorrhage control, disability, exposure up to secondary survey and preparation of prehospital and interhospital transportation are properly taken care of, better results will certainly be obtained.