Introduction: Frequent users contribute to an excessive volume of admissions in the emergency department, impairing the quality of healthcare services. The aim of this study was to identify and characterize the population of frequent users of the pediatric emergencydepartment, establish an individual plan of intervention and evaluate its efficacy.Material and Methods: Intervention study including children and adolescents younger than 16 years, with more than 10 visits in a year to an emergency department of a secondary care hospital. An intervention program was created with a multidisciplinary team and a case manager, who was responsible for the execution of the individual plan of intervention. One year later, the number of visits after the intervention was assessed.Results: We identified 90 patients with a frequent user profile, with 1182 visits. Only 17.3% of the visits had a previous referral. Most of the visits were considered non urgent/less urgent (59%). The intervention included 82 children/adolescents. One year later, there was a significant reduction in the number of visits: median reduction of 62% in 78 participants.Discussion: Most of the visits by frequent users were considered non urgent/less urgent, reflecting a clinically unjustified use of the emergency department. The intervention seems to be effective as the number of visits decreased.Conclusion: This population of frequent users seems to be a heterogeneous group with different problems and levels of complexity. A multidisciplinary and individual intervention, with a case manager, might contribute to reduce the excessive use of the emergency department and improve the provision of health care services to these children.

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Introdução: A tosse é um dos sintomas mais comuns em idade pediátrica. O recurso a fármacos é frequente, apesar da sua eficácia e segurança não estarem comprovadas. O objetivo deste estudo foi compreender a perspetiva que os cuidadores têm da tosse e descrever as medidas terapêuticas mais utilizadas. Métodos: Estudo transversal e observacional, que decorreu de fevereiro a abril de 2016, através da aplicação de um questionário a uma amostra de cuidadores de crianças admitidas na urgência pediátrica de um hospital de nível II. Resultados: Foram recolhidas 220 respostas. Quase todos os participantes eram pais (94%), do sexo feminino (82%), com idade média de 37 anos. Dois terços tinham o ensino secundário ou ensino superior. A maioria dos cuidadores (63%) considerou a tosse um mecanismo de defesa, embora tenham admitido ficar muito preocupados quando o seu filho tosse (56%). Mais de metade dos cuidadores (56%) admitiu ter administrado fármacos para a tosse no último Inverno, dos quais 62% foram prescritos por um médico. A utilização de fármacos foi maior nos pais com menor grau de instrução. A maioria dos pais considerou terem sido eficazes (72%) e apenas um terço os considerou como potencialmente perigosos. Discussão: Este estudo sugere que a tosse é um sintoma ainda mal compreendido pelos pais, levando a uma utilização frequente de fármacos. Verificou-se igualmente uma elevada prescrição médica. Destaca-se a importância da formação dos profissionais de saúde e dos pais para uma melhor abordagem da tosse na criança.

A baby girl was born at 29 weeks and 2 days gestation with a physical examination notable for petechial rash, hepatosplenomegaly, and hydrops. The baby was born before the mother could be rescreened for syphilis and non-treponemal tests were positive at birth. The first weeks of life were complicated by clinical instability and post-hemorrhagic hydrocephalus that probably resulted from a combination of prematurity and syphilis. During the 2nd month of life, she showed a failure to thrive, persistent hypoglycemia, and diabetes insipidus and was diagnosed with hypopituitarism. Hormonal substitution treatment was challenging and required multiple adjustments until satisfactory control was attained.