Especially for surgery and orthopedics it often happens that a minor is treated with adults, as shown by the data of the National Agency of Regional Health Services. Pediatric hospitals guarantee better therapeutic adherence for up to 18 years
THEL recovery hospital for a child is a traumatic time. Ensure a welcoming environment suited to his emotional, playful and cognitive needs, and asupport adapted to its biological characteristics by personnel trained in the pediatric area is an integral part of the treatment path. But in more than two out of ten cases, child-friendly health is still not a protected right. According to a calculation by the National Agency for Regional Health Services (Agenas), relative to 2019, 175,104 hospitalizations of patients between 0 and 17 years, equal to 25.19 per cent of the total (695,215, from which hospitalizations for childbirth), were carried out in adult wards. Especially when surgery was needed.
The scope orthopedic it is certainly the one most delegated to pediatric teams and settings (39,986 hospitalizations, i.e. 22.8 per cent), in particular for foot operations (7,834), followed by those for the removal of internal fixation devices to the lower limbs (6,415 ), knee (5,035), other interventions on the musculoskeletal system (4,710), tibia and humerus (3,986), hands and wrist (2,921), shoulder, elbow and forearm (2,783). In second place there are otolaryngology interventions (28,504 hospitalizations, equal to 16.2 per cent of the activity): most of them concern the removal of the tonsils and possibly of the adenoids (18,198). In third place, general surgery (20,072 hospitalizations, 11.4 percent), with numerous operations on the testicle (4.443, almost like those treated in the pediatric wards: 5.262), appendectomy (3.163), perianal (such as hemorrhoids and fistulas ) and pilonidal cysts (2,930). Another slice of children and adolescents are managed in areas for adults for ophthalmological (4,993 cases), urological (4,764), cardiological (4,164) and maxillofacial surgery (3,339) problems.
“The placement of pediatric patients in pediatric wards as well as representing a battle of civilization to be pursued, so that they receive appropriate care in a place suited to their needs, minimizing the uneasy perception of hospitalization and facilitating adherence to the therapy, it is also a struggle to be undertaken in favor of the quality of care and scientific research. Concentrating the volumes of services in specific departments makes it possible to guarantee better clinical outcomes »observes Alberto Zanobini, president of the Italian Pediatric Hospitals Association (Aopi), which groups together 15 structures, including the Meyer hospital in Florence of which he is general manager.
In the regions
In many parts of Italy, especially in peripheral pediatricians, taking charge stops at 14 years, other times it reaches 15 or 16. In the guideline document for the improvement of care standards in the pediatric-adolescent area, signed by State-Regions Conference in 2017, it was reported that 85 percent of patients aged 15 to 17 were managed in conditions of promiscuity with adult and elderly patients and with medical and nursing staff not specialized in childcare and childcare. adolescence. Yet, based on the provisions of the 1989 United Nations Convention on the Rights of the Child, ratified by Italy in 1991, there is no doubt about the definition of a minor, that is “every human being under the age of 18”, and on his right “to enjoy the best possible state of health and to benefit from medical and rehabilitation services” in relation to his specific needs. The importance of guaranteeing the specialty pediatric up to the age of 17 she is underlined both by Aopi and by the Italian Society of Pediatrics (Sip). «The pediatrician is also a doctor of adolescence, a phase in which biological development and growth continues. In the presence of chronic pathologies, such as asthma, diabetes, rheumatic or inflammatory diseases of the intestine, the evaluation of the course and the changes in therapy are linked to how the disease originated and typical manifestations of the developmental age “remarked Giovanni Corsello , full professor of Pediatrics at the University of Palermo. «An experienced team is able to intercept the symptoms in a more timely manner and to prescribe more appropriate treatments. Intestinal intussusception, for example, is an acute disorder that affects only minors and if it is not intervened in time, a portion of the intestine goes into necrosis. Febrile seizures also affect children and require different therapeutic modalities from those adopted for adults. While the delay in the diagnosis of type 1 diabetes, which occurs mainly in childhood and adolescence, can cause severe metabolic decompensation ».
“If the pediatric competence is lacking and you are not familiar with the problems of the child – adds Mario Lima, president of the Italian Society of Pediatric Surgery – there is the risk of resorting to invasive techniques or wrong that can cause complications, such as bleeding and post-operative infections, even after appendicitis or tonsillectomy. Among the interventions performed most often in younger patients by medical teams for adults are hernias, torsions of the testicle, malformations of the urinary tract, intestinal stenosis or atresias, pneumothorax, removal of ovarian masses “.
The pediatric ward offers a tailor-made care setting. “You don’t heal with drugs alone,” Corsello remembers. “Context also has a positive impact on prognosis. It reduces stress and promotes psychological acceptance of the treatment path, minimizing side effects, such as glycemic fluctuations in the case of diabetes and respiratory disorders, and avoiding attitudes of resistance, such as refusal to eat. Studies also show that children with cancer admitted to adult oncology have a lower survival and a higher incidence of complications ».
Another issue that the pediatric society is focusing on is the strengthening of pediatric intensive care units and the need to put them online. “In our country there are few, the estimate is 23 in all, with approximately 202 beds, an average of 3 places per one million inhabitants, well below the European average of 8. It is therefore assumed that the 50 percent of under 18s end up in intensive units for adults and this can affect the prognosis », says pediatrician Rinaldo Zanini, who conducted the survey for SIP. “The calculation is approximate because – he explains – there is not yet an identification code of this hospital discipline, which instead exists for all other branches of medicine and is essential to map the exact numbers of beds and wards”. Corsello raises the alarm: «We expect Covid to become a more widespread disease among children under 12, precisely because they cannot be vaccinated. But we are not ready for this emergency ». To strengthen the care response, discouraging the treatment of serious and complex patients within operating units with a low volume of activity, with a consequent increase in mortality, “it is necessary to define a system of hub and spoke (a network of reference centers and connected peripheral units, ed) that has the ability to intercept critical events in small hospitals in the area and therefore to distribute patients, according to a level of severity and age, in first or second level pediatric intensive care units or in super hubs where there are possibilities and skills to apply particular therapies such as Ecmo (extracorporeal membrane oxygenation, ed). And in support of this network, neonatal intensive therapies could enter »concludes Zanini. Organize all pediatric clinical pathways in a hub (for more complex cases) and spoke (for routine cases) network logic in order to ensure capillary management throughout the territory, close to the most fragile and chronic users , up to the home, also through the use of telemedicine. This is the goal of the working group that took office on May 28 at Agenas and coordinated by Francesco Enrichens, in which Aopi also participates. But in addition to the structural and logistical effort, there is the cultural one to face. «We need to intervene on migratory flows. Highly specialized centers cannot attract low complexity patients and vice versa. This mentality, widespread among citizens and health professionals, must be absolutely corrected ”concludes Zanobini.
January 24, 2022 (change January 24, 2022 | 20:26)
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