A Pediatric Patient With Ascites, Proteinuria, and Thrombocytopenia: A Rare Presentation for a Common Illness.

ABSTRACT: A 7-year-old female patient presented to our pediatric emergency department with 5 days of fever, sore throat, abdominal pain, vomiting, headache, and 2 days of periorbital swelling. Her initial laboratory evaluation revealed a negative monospot test, neutropenia, atypical lymphocytosis, and thrombocytopenia in addition to transaminitis and proteinuria. An abdominal ultrasound obtained identified hepatosplenomegaly, moderate ascites, acalculous cholecystitis, and a distended appendix with periappendiceal fluid. She was admitted to gastroenterology for further management with antibiotics and surgery and hematology consults. Ultimately, Epstein-Barr virus polymerase chain reaction was positive. This case highlights an atypical presentation of Epstein-Barr virus and the collaborative approach to diagnosis.

Social Risk Screening in Pediatric Primary Care Anticipates Acute Care Utilization.

OBJECTIVE: The aim of the study was to assess whether responses to a standardized social risk screen administered during pediatric well-child visits (WCV) were associated with emergency department (ED) or urgent care (UC) utilization. METHODS: This was a retrospective cohort study of 26,509 children younger than 13 years with a WCV between January 1, 2012, and December 31, 2013. Exposure was positive response(s) on a standardized social risk screening questionnaire at the index WCV. Primary outcome was number of ED or UC visits in the 12 months after the WCV. RESULTS: The cohort was 50.9% male and 65.7% black, with a median age of 3.6 years. More than 20% had a positive response to at least one question on the social risk screen. For those reporting any social risk, 46.7% had 1 or more EDs or UC visit within 12 months. Each additional reported risk was associated with a 4% increase in the rate of ED utilization (incidence rate ratio = 1.04, 95% confidence interval = 1.02-1.07) and a 16% increase in the rate of hospitalizations (incidence rate ratio = 1.16, 95% confidence interval = 1.08-1.24). Similar patterns were noted for those visiting the ED 4 times or more (adjusted odds ratio = 1.09, 1.03-1.15) and hospitalization 2 times or more (adjusted odds ratio = 1.19, 1.04-1.35) in the year after the WCV. Those who screened positive on food insecurity, safety, and desire to meet with a social worker questions also had higher odds of ED or UC utilization. CONCLUSIONS: Families reporting a social concern on a standardized screen during a WCV had increased acute care utilization in the subsequent year. Identifying socially at-risk families may allow for the creation of more effective strategies to prevent future utilization.

Severe Unintentional Injuries to Ohio Children: What We Should Be Addressing at Well-Child Visits.

This was a retrospective study examining severe injuries to Ohio children in order to provide pediatricians with targeted injury talking points at well visits. We included children ≤14 years old from the Ohio Trauma Acute Care Registry with severe unintentional injuries from January 1, 2003, to December 31, 2012. There were 45 347 patients; 611 died, and the mean age was 6.8 years. Fractures/dislocations were common (46.6%), and many injuries occurred at home (49.1%). In children ≤2 years old, the leading causes of injury were falls and burns/fire; falls and motor vehicle collisions (MVCs) predominated above this age. Leading causes of death were MVCs, drowning, and suffocation. We concluded that national data may not always reflect state-specific injury patterns. In Ohio, though falls and MVCs were the most common mechanisms, fire and drowning also caused significant injury. Given limited time to discuss injury prevention, pediatricians should concentrate on statewide injuries.