Children's Doctor News and Updates: Summer 2016

Published on in Children's Doctor

U.S. May Be Greatly Undercounting Pediatric Concussions

New research from CHOP and the Centers for Disease Control and Prevention (CDC) highlights a substantial gap in how the United States currently estimates the nation’s burden of pediatric concussions. Among 0- to 17-year-olds who have a CHOP primary care physician and were diagnosed with a concussion within CHOP’s regional pediatric network, 82% had their first concussion visit at a primary care site, 12% at the Emergency Department, 5% within specialty care (sports medicine, neurology, trauma), and 1% were directly admitted to the Hospital. Many current counts of concussion injury among children are based solely on E.D. visits or on organized high school and college athletics data. Thus, the authors say, we may be vastly underestimating child and youth concussions in the United States.

Kristy Arbogast, PhD, lead author and co-scientific director of CHOP’s Center for Injury Research and Prevention, also noted that one-third of patients were under age 12, and “therefore represent an important part of the concussion population that is missed by existing surveillance systems that focus on high school athletes.”

For the study, published in JAMA Pediatrics, researchers used the CHOP EHR to retrospectively analyze more than 8000 concussion diagnoses from July 2010 to June 2014. During that time, primary care visits as the point of entry increased 13%, with a corresponding 16% decrease in point-of-entry E.D. visits.

“This study provides direction for healthcare networks and clinicians about the critical importance of providing targeted training and resources in primary care settings,” says co-author Christina Master, MD, FAAP, CAQSM. Learn more about CHOP’s concussion work.

CHOP’s Division of Rheumatology Increases Access

The Division of Pediatric Rheumatology at CHOP welcomes Jay Mehta, MD, as clinical director. Also, Pamela Weiss, MD, MSCE, will see Rheumatology patients at the CHOP Care Network Brandywine Valley Specialty Care and Ambulatory Surgery Center starting August 1. New patients are now able to schedule an appointment within 14 days of referral. Call 215-590-2547. Read more »

CHOP Launches Leukodystrophy Center of Excellence

Children living with leukodystrophies now have access to state-of- the-art diagnostics and integrated multidisciplinary care at CHOP’s new Leukodystrophy Center of Excellence.
The center is a diagnostic, clinical care, and research initiative launched to address the complex medical needs of patients, advance therapeutic strategies, and prepare to implement Pennsylvania and New Jersey laws that added Krabbe leukodystrophy to the newborn screening panel. Early detection of all leukodystrophies also allows for preventive care strategies to improve quality of life for children and families.

Amy Waldman, MD, a CHOP pediatric neurologist and medical director, leads the center, which includes experts from neurology, metabolics, rehabilitative medicine, nutrition, complex care pediatrics., and physical, occupational, and speech therapies. For details, call 215- 590-6053 or visit chop.edu/leukodystrophy.

Lyme Disease or Serious Knee Problem?

When patients present with knee pain and swelling, it can be Lyme disease or it could indicate septic or pyogenic arthritis of the knee, a medical emergency requiring surgery to prevent irreversible knee damage.

A CHOP study, led by orthopedic surgeons Keith D. Baldwin, MD, MPH, MSPT, and Wudbhav N. Sankar, MD, reviewed the records of 189 patients under age 18 who presented at Children’s Hospital with excess fluid in the knee between 2005 and 2013. They revealed 4 factors that are predictive of septic arthritis: knee pain with a short arc range of motion; a C-reactive protein (CRP test; used to measure inflammation) of >4.0 mg/L; fever; and age younger than 2.

“The probability of septic arthritis with any one factor present was 18% compared to 100% with all 4 factors present,” says Sankar. The study was published in the Journal of Bone and Joint Surgery.

New Program Aims to Put Foster Children on Healthier Path

CHOP has created the Fostering Health Program (FHP) to help improve the health of children entering foster or kinship care. A multidisciplinary team of specialists, led by Philip V. Scribano, DO, MCSE, and Kristine Fortin, MD, MPH, provide a comprehensive assessment to identify the child’s medical, behavioral, emotional, and developmental needs, and to develop a care plan that ensures these needs are being met during the transition to foster care, or a new placement, and beyond.

Working closely with foster care families and Philadelphia’s Department of Human Services and its Community Umbrella Agencies, the goal is to ensure all foster children have access to continuous, coordinated, and high-quality care during this crucial period of transition in their childhood.

The team’s care plan, which often includes recommended treatments and referrals, is shared with the foster child’s primary care provider, DHS case workers, the foster parent and, when appropriate, the child’s biological parent. For more information, call Judy Dawson, RN, FHP, care coordinator, at 267-426-0982.