In the window of the Wellcome Collection in London artists work to interpret and explain science: it’s an impressive experience to the irregular visitor. When faced with the presenting problems of a child & family, we are faced with trying to do the reverse. We have the sometimes inaccurate recollections of history, the variable responses […]
Category: diagnostics
Q: Is an OGTT good enough for CF diabetes testing?
Jamie, a 13-year-old girl with cystic fibrosis (CF), has been referred to the Paediatric Diabetes clinic because of an abnormal oral glucose tolerance test (OGTT) in her recent CF Annual Review. It showed impaired glucose tolerance. Continuous glucose monitoring system (CGMS) over three days showed normal fasting and pre-prandial glucose but frequent post-prandial glucose excursions […]
MRI-brain for microcephaly?
A 7-year-old boy was referred for medical assessment as part of the process of producing a statement of special educational needs. There had been no medical concerns in the past and there was no family history of note. On examination, the boy was noted to be micro cephalic with head circumference on the 0.4th centile, […]
Q: FRAX testing for Autistic Boys?
You diagnose a 5-year-old with Autistic spectrum disorder. His examination is unremarkable and there is no family history of learning difficulties. Should you perform a molecular genetic screen for FMR1 mutations (fragile X)? […]
Disease spectrum vs disease prevalence
In examining a diagnostic test, we make the assumption that the characteristics of the test – its sensitivity and specificity (or likelihood ratios, the way I prefer to think) – will stay constant across different populations, although the positive and negative predictive values will change * . This is sort of true, and sort of […]
Irritating hip or rotting femur?
A 3 year old boy presents to the Emergency Department with a limp. He has been reluctant to weight bear on his right leg during the day and has a temperature of 37.9°C. Hip examination is painful. What clinical or laboratory tests could help discriminate between septic arthritis and transient synovitis? Of course, you could […]
Question: How to diagnose and treat pyelonephritis
In children suspected of having a UTI, what clinical and radiological features diagnoses pylonephritis, and what mode of antibiotic treatment is necessary to produce clinical improvement and avoid chronic renal impairment? With the publication of the NICE guidance in the UK on the management of UTI in childhood, many paediatricians have been spurred to review […]
Question: Hip scans for clubfoot babies?
Do infants born with an isolated clubfoot (talipes equinovarus) require radiological investigations to rule out congenital hip dysplasia? You are a neonatal SHO. The midwife asks you to see a term baby who has just been born. She has noticed the baby to have a clubfoot and wants you to examine the baby.Physical examination confirms […]
New things in evidence synthesis
The days of a meta-analysis being the simple adding up of lots of studies, pretending that they are all just tiny pieces of the One Big Trial that was performed before the world was made are on their way out. Newer ways of using synthesised evidence – like meta-regression and individual patient data analysis – […]
Unanswered Question: Do children with autism and developmental regression need EEG investigation in the absence of clinical seizures?
John diagnosed with autism at 18 months old presents to your developmental clinic at 30 months old. His mother reports developmental regression of previously acquired developmental milestones. He has now lost his previously acquired language skills and only makes incomprehensible babbles. He is otherwise clinically well and does not have any clinical seizures. You wonder […]