Symptomatic neurocutaneous melanosis: mild clinical onset in a teenager.

Neurocutaneous melanosis (NCM) is a rare disorder characterised by giant or multiple melanocytic nevi and meningeal melanosis or melanoma. Onset of neurological symptoms is typically in children younger than 2 years and can be rapidly fatal. We present the case of a 13-year-old adopted girl presenting with numerous congenital melanocytic nevi and a seizure. She had no significant previous neurological history. Electroencephalogram showed epileptiform discharges over the right frontal region. MRI of the brain showed T1 hyperintensity in the bilateral amygdala and anterior temporal lobes with corresponding hyperintensity on T2 and fluid attenuated inversion recovery. There was no hydrocephalus. Along with the history of nevi, these imaging findings were concerning for NCM. The patient is being managed with levetiracetam and trametinib and shows no further neurological decline at 1-year follow-up, providing prognostic hope in this case of NCM.

Evaluation of a child guidance model for visits for mental disorders to an inner-city pediatric emergency department.

BACKGROUND: To address a rising trend of emergency department (ED) visits for mental disorders (VMD), our ED implemented a child guidance model for their efficient evaluation and disposition. OBJECTIVES: The main objective of our study was to evaluate the impact of the child guidance model on the ED length of stay (LOS) and ED costs on children with VMD. METHODS: We conducted a retrospective chart analysis on 1031 VMD visits made to an inner-city tertiary care pediatric ED in 2002 (1.4% of the total 2002 ED visits). We collected demographic and LOS information on all VMD visits. The child guidance model was implemented June 2002, after which we divided the VMD cases into 2 groups based on the presence or absence of the model. We performed a cost analysis to assess the impact of the model on LOS and determined the opportunity costs of prolonged LOS of the VMD visits as compared with 500 non-VMD visits. RESULTS: The average LOS of VMD visits was longer than that of the 500 non-VMD visits (236.04 minutes +/- 162.82 vs. 134.69 minutes +/- 95.19; mean difference, 101.34 minutes; P = 0.001). The LOS was significantly reduced after the model was implemented (259.49 minutes +/- 171.12 vs. 216.39 +/- 152.95 minutes, P = 0.00). The lost revenue due to extended VMD LOS was calculated as opportunity costs of $201,173.30, whereas the cost savings during the study period due to reduced LOS after the model was implemented was $10,651. CONCLUSIONS: This study suggests that children with VMD visits contribute a substantial resource burden in the ED, and focused interventions such as the child guidance model in the ED can significantly decrease LOS and reduce ED costs.