Age ain’t nothin’ but a number? You are only as young as you feel? When it comes to pediatric abdominal surgical disease is timing really is everything? Hopefully, you enjoy the rule of six (credit to Dr. Dave Nelson for this) as a framework for the common presentation of abdominal surgical disease in the pediatric patient.

Pediatric Abdominal Surgical Disease: The Rule of 6

Check out episode 8 of PEMGEMS recently released by Dr Joe Ravera!

https://pemgems.com/rule-of-6/

 

Pediatric DKA: Going Beyond Fluids, Insulin and Admit to PICU

New episode from Dr Ravera and PEMGEMS.

“Making the diagnosis of DKA takes about 30 seconds. But before we open up the order set, check some boxes, and send the kid upstairs, let’s think about how we can fine-tune our care. What complications do we need to look out for and how can we manage them? “

 

“Pediatric patients presenting with prolonged fever and laboratory signs of inflammation have a broad differential. In addition to the standards, such as viral illness and bacterial infection, we need to consider the inflammatory states of KD, TSS, and the emerging MIS-C. Join us on this journey through the fire and we review these three conditions in a podcast that accompanies a blog post for EMdocs.net.”

Flame On! The Hot Mess that is Kawasaki Disease, Toxic Shock Syndrome, and Multi-Inflammatory Syndrome of Children

Check out episode 6 of PEMGEMS recently released by Dr Joe Ravera!

https://pemgems.com/flame-on/

 

Bad Puns and Pre(Pee)-Test Probabilities

New episode from Dr Ravera and PEMGEMS out 7/24.

“To people who know me, it will come as no surprise that I love statistics and bad puns. So have fun streaming this e-piss-ode as we learn about whom to test, how to test, and what to do with the result. We also reveal a PEM GEMS exclusive: Ravera’s Spectrum, the Joe Ravera approach to the diagnosis of pediatric UTI. Hopefully you find this to be liquid gold!”

 

By Jack Dubuque, MS4

“Case reports are of minor importance in evidence-based medicine; however, they make meaningful contributions to both the knowledge and education of medical students, residents, and fellows” – Florek and Dellavalle, Journal of Medical Case Reports 2016.

What is a case report?

A case report is a detailed narrative about a clinical patient encounter. Often case reports highlight the first presentation of communicable illnesses, rare and unusual disease presentations, or adverse events of treatments.

 

Why write a case report?

In the Emergency Department case reports raise the alarm for the medical community to new  events. Emerging communicable illnesses like COVID-19 global pandemic, ebola, anthrax, HIV and AIDS, and zika virus are some recent examples. Other events such as novel and dangerous street drugs can be linked together with case reports from hospitals across the country.

Research has been playing an increasingly important role in the education and the experience of medical students. In the current residency application environment, research and publications play a much larger role than in the recent past.

Case reports are often the first foray into medical writing for students. Encouraging students to become more involved in research and to foster the academic spirit is of vital importance. With the rapidity of publication for case reports as compared to more extensive studies such as randomized control trials, case reports offer an opportunity for quick publication for students and clinicians who may not have the time to see a more involved study to completion.

How to structure your case report

In 2013 the CARE (CAse REports) guidelines were developed by an international group of experts in order to aid authors in their creation of accurate, transparent, and useful case reports. These guidelines have been endorsed by several medical journals and publishers.

2013 CARE Checklist

  1. Title – The diagnosis or intervention of primary focus followed by the words “case report”.

  2. Key Words – 2 to 5 key words that identify diagnoses or interventions in this case report (including “case report”).

  3. Abstract – (structured or unstructured)

    • Introduction – What is unique about this case and what does it add to the scientific literature?

    • The patient’s main concerns and important clinical findings.

    • The primary diagnoses, interventions, and outcomes.

    • Conclusion – What are one or more “take-away” lessons from this case report?

  4. Introduction – Briefly summarizes why this case is unique and may include medical literature references.

  5. Patient Information

    • De-identified patient specific information.

    • Primary concerns and symptoms of the patient.

    • Medical, family, and psychosocial history including relevant genetic information.

    • Relevant past interventions and their outcomes.

  6. Clinical Findings – Describe significant physical examination (PE) and important clinical findings.

  7. Timeline – Historical and current information from this episode of care organized as a timeline (figure or table).

  8. Diagnostic Assessment

    • Diagnostic methods (PE, laboratory testing, imaging, surveys).

    • Diagnostic challenges.

    • Diagnosis (including other diagnoses considered).

    • Prognostic characteristics when applicable.

  9. Therapeutic Intervention

    • Types of therapeutic intervention (pharmacologic, surgical, preventive).

    • Administration of therapeutic intervention (dosage, strength, duration).

    • Changes in therapeutic interventions with explanations.

  10. Follow-up and Outcomes

    • Clinician- and patient-assessed outcomes if available.

    • Important follow-up diagnostic and other test results.

    • Intervention adherence and tolerability. (How was this assessed?)

    • Adverse and unanticipated events.

  11. Discussion

    • Strengths and limitations in your approach to this case.

    • Discussion of the relevant medical literature.

    • The rationale for your conclusions.

    • The primary “take-away” lessons from this case report (without references) in a one paragraph conclusion.

  12. Patient Perspective – The patient should share their perspective on the treatment(s) they received.

  13. Informed Consent – The patient should give informed consent. (Provide if requested.)

A printable version of the checklist can be found here.

References:
1. CARE Case Report Guidelines. CARE Case Report Guidelines. Accessed July 13, 2020.
2. Florek AG, Dellavalle RP. Case reports in medical education: a platform for training medical students, residents, and fellows in scientific writing and critical thinking. Journal of Medical Case Reports. 2016;10(1):86. doi:
3. Guidelines To Writing A Clinical Case Report. Heart Views. 2017;18(3):104-105. doi:
4. Murphy L. Research Guides: Evidence-Based Medicine Subject Guide: EBM Pyramid. Accessed July 13, 2020.
5. The Case for Case Reports. Accessed July 13, 2020.
6. Top Ten Tips for Writing an Effective Case Report (Part 1). Enago Academy. Published September 26, 2016. Accessed July 13, 2020.