Author Rachel J. Kwon, MD

Interview with Dr. Ilene Claudius, Part 2 of 2: Pediatric Mass Casualty and Systemic Failures in Child Abuse

Rachel J. Kwon, MD
dr-ilene-claudius

Dr. Ilene Claudius

Can you tell us about your research in pediatric mass casualty incidents (MCI)? How did you develop an interest in pediatric mass casualty? Was there a particular patient experience that you had?

I haven’t had a personal experience with it, necessarily—we’ve certainly had some overwhelming car accidents, but nothing to the level that I would call a true pediatric mass casualty incident. These are always tragic events, and especially after Sandy Hook, it became clear that kids could make up a sizable portion if not the entirety of the victim population of an MCI.

We’ve done a lot of work in the PEM [pediatric emergency medicine] community on general community hospitals being ready to see a lot of kids in general. I work with an organization called COPEM [Committee on Pediatric Emergency Medicine] that looks at our pediatric receiving hospitals and makes sure they’re up to standard in terms of delivering pediatric care and having the appropriate supplies. And that’s just for a single routine pediatric patient. So the thought of how a group of very traumatized pediatric patients simultaneously is going to be handled is something we discuss a lot. Continue reading “Interview with Dr. Ilene Claudius, Part 2 of 2: Pediatric Mass Casualty and Systemic Failures in Child Abuse” →

Interview with Dr. Ilene Claudius, Part 1 of 2: Managing Suspected Child Abuse in an Emergency Setting

Rachel J. Kwon, MD
dr-ilene-claudius

Dr. Ilene Claudius

Ilene Claudius, MD, is an associate professor of clinical emergency medicine and chief of pediatric emergency medicine at the Keck School of Medicine of the University of Southern California. She is editor-in-chief of Pediatric Emergency Medicine Practice, and her clinical research interests include pediatric mass casualty, non-accidental trauma (child abuse), and pediatric mental health.

Dr. Claudius has also studied apparent life-threatening events (ALTE) and brief resolved unexplained events (BRUE). She has authored or co-authored dozens of studies in peer-reviewed journals, and is an active contributor to the EM:RAP podcast. We talked to Dr. Claudius about her research and clinical expertise in pediatric emergency medicine.

Continue reading “Interview with Dr. Ilene Claudius, Part 1 of 2: Managing Suspected Child Abuse in an Emergency Setting” →

Insights from Dr. Lise Nigrovic, Creator of the Bacterial Meningitis Score for Children

Rachel J. Kwon, MD

Bacterial meningitis is a rare but serious disease, with mortality approaching 100% when left untreated. On the flip side, many children with mild viral illness are admitted with questionable benefit. The Bacterial Meningitis Score can help support a clinician’s decision to discharge a child safely. We talked with Dr. Lise Nigrovic, first author on the derivation and validation studies.

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Dr. Lise Nigrovic

Why did you develop the Bacterial Meningitis Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians? 

When I was a resident in pediatrics, I found myself admitting well-appearing children who had meningitis, spent two days in the hospital, and then went home after their cultures were negative. Doing that over and over again made me wonder if we could do better and distinguish between children who

Continue reading “Insights from Dr. Lise Nigrovic, Creator of the Bacterial Meningitis Score for Children” →

Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis

Rachel J. Kwon, MD

Antibiotic overuse and misuse is a growing public health concern, and foregoing the administration of antibiotics in cases where they are not needed can be a challenging decision to defend without good evidence to back it up. The Centor Score for Strep Pharyngitis is one of the most practical and useful evidence-based decision tools that helps support clinicians in making those decisions. We interviewed Dr. Robert Centor on developing and using the Centor Score.

dr-robert-m-centor

Why did you develop the Centor Score? Was there a clinical experience that inspired you to create this tool for clinicians?
In 1979, while working in the “non-acute” adult emergency room, a resident asked me how to evaluate a sore throat patient. Having just finished my residency, I started to give a definitive answer, but had a moment of humility and told him that I did not know. We made a treatment decision at the time, and I went to the library to learn more. Continue reading “Insights from Dr. Robert M. Centor, Creator of the Centor Score for Strep Pharyngitis” →

Insights from Dr. Jeffrey Perry, Creator of the Ottawa Subarachnoid Hemorrhage Rule

Rachel J. Kwon, MD

Subarachnoid hemorrhage, if undiagnosed, can have devastating consequences. While headache is a common presenting complaint in emergency departments, only about 1% of these patients are diagnosed with SAH. The Ottawa SAH Rule helps rule out SAH with 100% sensitivity, to better identify which patients do and do not need further workup. We talked with Dr. Jeffrey Perry, first author of the Ottawa SAH Rule derivation study.

dr-jeffrey-j-perry

Dr. Jeffrey J. Perry

How did you develop the Ottawa SAH Rule? Was there a particular patient or clinical experience you had?

Two things: One was the apparent subjectivity I noticed as a resident in evaluating patients for SAH, where the criteria for which patients we would investigate seemed to be very different. Some of the patients I thought were very low risk, other physicians would want to still investigate them for SAH, including doing a CT, which didn’t bother me too much, but then they would go on to do an LP, which is very uncomfortable, and time-consuming, and it seemed to contribute to already very prevalent ED overcrowding. So that was the clinical side of things. Continue reading “Insights from Dr. Jeffrey Perry, Creator of the Ottawa Subarachnoid Hemorrhage Rule” →

Insights from Dr. William Knaus, Creator of the APACHE II Score

Rachel J. Kwon, MD

The APACHE II Score is the most-referenced risk score for ICU mortality, with over 15,000 citations in PubMed since its publication 22 years ago, and is still used today both clinically and in research. We talked with Dr. William Knaus, first author on the APACHE paper, about his experience in developing the APACHE II Score, as well as the increasing need for technology in healthcare (and its disappointing uptake and implementation).

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Dr. William Knaus

When we started [developing APACHE] in the 1970s, DRGs [diagnosis-related groups] were just coming on the scene, and obviously they were oriented towards the business and financing aspects of healthcare. There’s little correlation to the clinical. But people were relying on DRGs as a way to classify and identify patients, especially in the ICU. So it was important at that time to not so much reinvent the diagnostic system, but to talk about how patients come in at different levels of severity. And at that time, there was really nothing out there. Continue reading “Insights from Dr. William Knaus, Creator of the APACHE II Score” →

Dr. Paul Marik Responds: Vitamin C in Sepsis

Rachel J. Kwon, MD
marik

Dr. Paul Marik

On April 7, 2017, Paging MDCalc published an interview with three critical care experts regarding the Marik et al study on vitamin C in sepsis. Here is Dr. Marik’s response:

There are $20 billion reasons why there are so many skeptics, and they simply don’t understand the enormous body of research. We did not suck this out of thin air. I really don’t mind the skeptics; it generates discussion, and has raised awareness of the treatment and sepsis (that’s good). Unfortunately, patients will die while skeptics debate its merits. Continue reading “Dr. Paul Marik Responds: Vitamin C in Sepsis” →

First Scurvy, Now Sepsis: Is Vitamin C the New Old Wonder Drug?

Rachel J. Kwon, MD 1 Comment

See Dr. Marik’s response to this article. 

fresh-orange-juice-529486301-5828e1903df78c6f6abe5c9aA recent small single-center before-and-after trial by Marik et al showed that vitamins in combination with other relatively safe therapies may improve outcomes in sepsis. We asked three critical care physicians to give their thoughts on the debate on vitamin C in sepsis, and our own co-founder and healthcare finance expert Joe Habboushe to weigh in on the cost/price argument. Continue reading “First Scurvy, Now Sepsis: Is Vitamin C the New Old Wonder Drug?” →

“Doc, do I really need this operation? What are the TRUE risks?” Improving the conversation around surgical risk using evidence-based medicine

Rachel J. Kwon, MD

A 70-year-old woman with peptic ulcer disease comes to the ED with sudden severe abdominal pain. She also has a history of diabetes and hypertension, both well controlled with oral medication. Her vitals at triage show low-grade tachycardia but are otherwise within normal limits. She is peritoneal on exam and an upright chest x-ray reveals free air. While labs are pending, she is made NPO and started on IV fluid resuscitation.

You are the general surgeon called to see the patient, and your history and Continue reading ““Doc, do I really need this operation? What are the TRUE risks?” Improving the conversation around surgical risk using evidence-based medicine” →

Don’t Forget the Zebras: Familial Hypercholesterolemia

Rachel J. Kwon, MD

Did you know that FH is very treatable but missed in 90% of cases, and leads to early cardiac death? We’ve added some calculators to try to address it:

Unless you’re an endocrinologist, FH is one of those diseases you probably memorized in medical school, brought up on rounds when the Continue reading “Don’t Forget the Zebras: Familial Hypercholesterolemia” →