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Carpal coalitions are congenital segmentation anomalies with an abnormal union of one or more carpal bones. They can be broadly classified as osseous or non-osseous and as partial or complete. Lunotriquetral coalitions are the most common type of carpal coalition and are typically asymptomatic and detected incidentally. However, there are several case reports and small case series reporting symptomatic non-osseous lunotriquetral coalitions, which show findings on radiographs. This is a report of a case of a child with a symptomatic non-osseous lunotriquetral coalition which was undetected on initial radiographs but diagnosed on a subsequent wrist magnetic resonance imaging (MRI).

The International Consensus Definition for Sepsis and Septic Shock Task Force has recently developed new methods to determine whether a patient is at risk for end organ failure after he has been suspected to have sepsis. One of the newest measures developed is a quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA), and it is used to identify patients who are at risk of sepsis outside the intensive care unit. The systemic inflammatory response syndrome (SIRS) score has previously been the standard for determining a patient’s sepsis risk and prognosis for future mortality. With the development of these new tools, it is imperative to compare qSOFA to SIRS in order to determine which method is best and under which circumstances. We conclude that according to evidence currently available, qSOFA has limited use for patients in the intensive care unit at the time of evaluation for predicting mortality and organ dysfunction. Furthermore, qSOFA outranks SIRS for patients in the emergency department except for SIRS delivering positive results more quickly.