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Background: Autopsy has traditionally been the criterion for determining cause of death and has played a major role in medical education and quality control. With increasing use of bedside technology, however, autopsy rates have steadily declined. Objective: To identify (1) trends in pediatric autopsy rates during the past decade, (2) concordance between antemortem and postmortem diagnoses, and (3) patient characteristics influencing autopsy rates or diagnostic yield. Methods: All pediatric deaths between January 1, 1984, and December 31, 1993, were retrospectively reviewed. Data collection included demographics for an patients, and length of stay, diagnostic imaging studies, antemortem diagnoses, and autopsy findings for patients with autopsies. Autopsy diagnoses were compared with antemortem findings and classified according to their concordance. Results: Of 297 pediatric deaths, autopsies were performed on 107 patients (36%). Autopsy rates did not change significantly during the study period. Autopsies were not associated with patient gender, race, or insurance status, but increased significantly with age. Autopsies were performed in 26% of infants 12 months or younger, 60% of children between 13 to 60 months of age, and 100% of children 61 months or older ([chi square]; P [is less than] .001). In 34% of cases, new diagnoses were made at autopsy, including 7 cases where new findings, if known before death, would likely have resulted in a change in treatment or improved survival. There was no relationship between new findings at autopsy and age, length of hospital stay, or antemortem imaging studies. Conclusion: Autopsy can provide additional information in more than one third of pediatric deaths. Pediatric autopsy continues to provide clinically significant data and remains a valuable tool in modern pediatric practice. Arch Pediatr Adolesc Med. 1998;152:558-563, Autopsies can provide additional information on the cause of death in children. Researchers analyzed 297 pediatric deaths at one hospital between 1984 and 1993. An autopsy was done in 36% of the cases over the 10-year period. This autopsy rate remained relatively stable throughout the period. in 34% of the cases, the autopsy provided new information that led to a change in the diagnosis. In seven cases, this information might have led to a change in treatment while the child was alive. Infants were less likely to have an autopsy than older children.

Background An understanding of the health conditions affecting pediatric refugees is essential to providing responsible health care for them when they arrive in the United States. Objective: To assess the health status of pediatric refugees in an area of increased refugee resettlement. Design: Retrospective medical records review. Setting: Ambulatory clinic at Maine Medical Center in Portland, a community and referral hospital. Patients: One hundred thirty-two refugees and immigrants aged 2 months through 18 years who had initial health care evaluations during 1994 and 1995. Results: Sixty-six patients arrived from Africa, 22 from the former Yugoslavia, and the remainder from the former Soviet Union, Middle Asia, Southeast Asia, and Latin America. The mean age of the patients was 10 years; 56 (42.4%) were female. The overall health status of most of the children was good, with most having appropriate weight and height for age. Dental caries and dermatologic conditions were the most prevalent findings on physical examination. Two patients had evidence of traumatic injuries. The results of tuberculin (Mantoux) tests were positive ([is greater than or equal to] 10 mm) in 45 (35.2%) of 128 children for whom results were noted, hepatitis B surface antigen was detected in 5 (4.0%) of 124 children, and hepatitis B surface antibody was detected in 26 (21.1%) of 123 children. Five (16.7%) of 30 children younger than 6 years had elevated blood lead levels; anemia was detected in 25 (19.7%) of 127 children with hematocrit results available. Stool specimens were obtained from 87 patients, of whom 38 (43.7%) had pathogenic parasites in at least 1 specimen. Conclusions: Pediatric refugees arrive in the United States with a variety of conditions that may be unfamiliar to practitioners trained in this country. The results of this study support the screening of refugees from Africa and other regions for tuberculosis, stool parasites, and hepatitis B. Arch Pediatr Adolesc Med. 1998; 152:564-568, Pediatricians need to screen all refugee children for communicable diseases. Physicians screened 132 immigrant children and teenagers who settled in Portland, Maine. About half were from Africa and the rest were from Asia, Latin America and the former Soviet Union. Thirty-five percent had a positive tuberculosis test and about 25% tested positive for hepatitis B exposure. Seventeen percent had elevated blood lead levels and 20% had anemia. Almost half of 87 children tested positive for parasites.

Context: Group A [Beta]-hemolytic streptococcus (GABHS) pharyngitis is a common childhood illness. The clinical diagnosis is difficult to determine and laboratory tests have limitations; hence, the condition is generally overdiagnosed and overtreated. Several clinical pediatric-specific predictive models have been published but none have been prospectively studied. Objective: To test the performance of a previously published predictive model for GABHS pharyngitis in children in different clinical settings and during different seasons. Design: Prospective cohort study. Settings: Pediatric emergency department and 2 pediatric outpatient clinics. Patients: Children aged between 1 and 18 years with pharyngitis on initial examination at study sites between April 1, 1999, and March 31, 2000. Interventions: Recording of clinical features during initial evaluation using a standardized form and recovery of GABHS from patients' throats using reference standard methods. Main Outcome Measures: Posttest probability for GABHS positive throat culture associated with the model's positive predictors (moderate to severe tonsillar swelling, cervical lymphadenopathy [moderate to severe tenderness and enlargement of cervical lymph nodes], scarletiniform rash, and the absence of coryza) and the models' negative predictors (absence of the above signs and the presence of coryza). Results: Of 587 patients analyzed, 218 (37%) had a positive throat culture for GABHS. Forty-nine percent were boys. Mean [+ or -] SD age was 6.7 [+ or -] 3.9 years. There was no difference between the subsets within the sample. The posttest probability values for a positive throat culture associated with positive and negative predictors of the model were 79% and 12%, respectively. Conclusions: A pediatric predictive model for GABHS pharyngitis performed better than physicians' subjective estimates for a positive throat culture and was comparable with a rapid antigen detection test. The model performed consistently well in different populations and across seasons. It can be useful if reliable microbiological testing and/or follow-up are not attainable. Arch Pediatr Adolesc Med. 2001;155:687-691

Redness, eruptions, swelling, and discharge in the throat may be indicative of group A streptococcal infection in children with pharyngitis. Researchers compared symptoms and diagnostic test results from 192 children with serious sore throats. Eruptions on the palate and uvula, redness of the throat, tonsils, and uvula, and other symptoms were significantly more common in children with strep throat. No combination of predictive symptoms was strongly enough associated with streptococcal infection, so a diagnostic throat culture or antigen detection test is still required.

Objectives: To describe the pediatric interview as it is conducted in different practice settings and with children ranging in age from infancy to adolescence, and to identify pediatric history-taking strategies that varied across age groups. Participants and Methods: A self-administered survey was designed and mailed to a group of pediatricians in the Chicago metropolitan area to assess commonly used strategies in the pediatric interview across varied patient ages and settings. The pediatricians sampled varied by geographic location as well as by practice setting. Results: Results of the survey indicated that pediatricians use common strategies for establishing rapport, calming the disruptive child, and obtaining information from the child within particular age groups, but vary these strategies as the child matures. Conclusions: The findings substantiate the influence of the developmental stage of the child on interview strategies used by pediatricians. Implications pertaining to development of a standardized teaching curriculum for the pediatric interview are also discussed. Arch Pediatr Adolesc Med. 1999;153:154-157, Pediatricians use a variety of techniques to calm their patients, establish rapport, and elicit information about the child's health during a medical visit. Researchers surveyed 250 pediatricians, and found that most use calm talking, questioning, drawing, toys, and other techniques when treating children. Seventy-nine percent of doctors conducted an interview with school-aged children with parents present, while only 8% interviewed adolescents with their parents present. Urban and female pediatricians inquired about sexual and substance use issues when patients were younger. The use of verbal techniques to calm and question the patient became more common as children grew older.