Abstract

A well-qualified and dedicated pediatrician in a mid-Atlantic state recently cared for a 4-year-old child with a fever and a truncal rash. On the second visit the child was lethargic but seemed to improve with oral hydration and fever control. Twenty hours later the child's rash became petechial and the child returned moribund and died shortly thereafter. Looking for an emergency differential diagnosis on a 4-year-old child with fever and a truncal rash would have been cumbersome using traditional reference materials. With PEM-DXP, however, a nurse or secretary could have produced for the physician in 60 seconds a list of 12 emergency diagnoses to be considered. Rocky Mountain spotted fever would have appeared on that list. (Ten percent of patients with Rocky Mountain spotted fever have a maculopapular rash, and in 10% of those children the rash begins on the trunk.) This list might have prompted this physician to ask about a tick bite. A positive response would have been obtained. Possibly the tragic outcome, for both the child and the physician, could have been avoided. Children with urgent complaints are frequently cared for by physicians who are busy, tired, sleep-deprived, and stressed in many other ways. These physicians often have not read last month's medical journals in their specialty or even last year's journals. Yet the parents' expectation, and rightly so, is that their pediatrician or emergency physician has at his or her command and is bringing to bear on the care of their child the vast knowledge base of medical science as it pertains to their child's condition. It is a totally unrealistic expectation. By computerizing reference materials in ways that allow for selectively searching for and compiling information pertinent to a given presentation, however, we can move a bit closer to meeting both the parents' expectations of us and our own expectations of ourselves.