Tuesday, January 17, 2017

Time to Tweak our Lead-Screening Questionnaire?

In the hierarchy of evidence, aka the "evidence pyramid," retrospective case series don't rank very highly. However, this one is worth consideration for changing your practice in screening children for lead poisoning risk.

Source: Keller B, Faciano A, Tsega A, et al. Epidemiologic characteristics of children with blood lead levels ≥45μg/dL. J Pediatr 2017; 180:229-234. doi:10.1016/j.jpeds.2016.09.017. See AAP Grand Rounds commentary by Dr. Jeffrey Winer (subscription required). 

Tuesday, January 10, 2017

Certainty in Medicine: Dream On, Especially for Appendicitis Diagnosis

Uncertainty is inherent in medical practice, but that doesn't mean we shouldn't strive for accuracy in our medical decision-making. This study on sonographic diagnosis of appendicitis points to the difficulties involved in decision making based on relatively subjective criteria.

Source: Telesmanich ME, Orth RC, Zhang W, et al. Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams. Pediatr Radiol. 2016;46(11):1539-1545; doi: 10.1007/s00247-016-3645-4. See AAP Grand Rounds commentary by Dr. Michelle Stevenson (subscription required).

Tuesday, January 3, 2017

Why Can't We Refer SCFE in a Timely Manner?

This article really surprised me. How can we be so tardy in diagnosing slipped capital femoral epiphysis?

Source: Schur MD, Andras LM, Broom AM, et al. Continuing delay in the diagnosis of slipped capital femoral epiphysis. J Pediatr. 2016;177:250-254; doi:10.1016/j.jpeds.2016.06.029. See AAP Grand Rounds commentary by Dr. William Hennrikus (subscription required). 

Sunday, January 1, 2017

Happy 2017!

Happy New Year to everyone, and welcome to January's issue of AAP Grand Rounds* and another month of my postings, including a 5th Tuesday post on the 31st.

This month's AAP Grand Rounds includes a couple of comments on UTI articles, some new thoughts about managing in-hospital cardiac arrest, and more. I'll be commenting the next 4 Tuesdays on diagnostic problems with slipped capital femoral epiphysis, use of sonography in appendicitis, more on elevated lead levels in children, and management of that nebulous periodic fever syndrome, PFAPA.

Please join me!

*Note as of mid-morning Eastern time, this link was still showing December's issue. Be patient, maybe the web site is still recovering from a festive New Year's Eve!

Tuesday, December 27, 2016

A Spoonful of Sugar Not Too Helpful in Today's Medicine

I think we all could have guessed the result of this study, but sometimes even the "obvious" needs to be confirmed with good science.

Source: Yin HS, Parker RM, Sanders LM, et al. Liquid medication errors and dosing tools: A randomized controlled experiment. Pediatrics 2016 138: pii:e20160357. doi:10.1542/peds.2016-0357. See AAP Grand Rounds commentary by Dr. Mike Dubik (subscription required).

Tuesday, December 20, 2016

Are MRIs Dangerous for Fetuses?

Medical studies usually have nuanced conclusions, so putting the right "spin" on interpretation of the results is important. This study represents one of the few times I noticed that the lay press did a better job explaining the results than did the medical press.

Source: Ray JG, Vermeulen MJ, Bharatha A, et al. Association between MRI exposure during pregnancy and fetal and childhood outcomes. JAMA. 2016;316(9):952-961; doi:10.1001/jama.2016.12126 doi: 10.1001/jama.2016.12126. See AAP Grand Rounds commentary by Dr. Dan Doherty (subscription required).

Tuesday, December 13, 2016

Don't Drink the (Swimming) Water

This study, tucked away in a public health journal that most clinicians never see, is a testament to how meticulous data collection and analysis can lead to some simple conclusions. It's hard to debate the reliability of the results when the investigators go to such lengths.

Source: Arnold BF, Wade TJ, Benjamin-Chung J, et al. Acute gastroenteritis and recreational water: highest burden among young US children. Am J Public Health. 2016;106(9):1690-1697; doi:10.2105/AJPH.2016.303279. See AAP Grand Rounds commentary by Dr. Philip Rosenthal (subscription required).

Tuesday, December 6, 2016

What is a Guideline?

This article caught my eye, because the authors were reporting on how often clinicians followed guidelines for ordering spinal ultrasonography on newborns with sacral dimples. The problem is, I'm not sure there is such a guideline.

Source: Wilson P, Hayes E, Barber A, et al. Screening for spinal dysraphisms in
newborns with sacral dimples. Clin Pediatr. 2016;55(11):1064-1070; doi:10.1177/0009922816664061. See AAP Grand Rounds commentary by Dr. Jonathan Mintzer (subscription required).

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