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Megan Ward,1 Peter Nguyen,1 Simi Akintorin,2 Rosibell Arcia,1 Kenneth Soyemi1,3 1Department of Pediatrics, Cook County Health, and Hospitals System, The John H. Stroger Jr. Hospital, Chicago, IL, USA; 2Keck School of Medicine, University of Southern California Medical School, Los Angeles, CA, USA; 3Department of Emergency Medicine, Cook County Health, and Hospitals System, The John H. Stroger Jr. Hospital, Chicago, IL, USA Introduction: Our study objective was to determine the health care provider liver enzyme screening testing (LEST) rates in obese pediatric patients at risk for nonalcoholic fatty liver disease (NAFLD), with the goal of improving NAFLD LEST after specific system-wide provider intervention.Methods: We conducted a bi-phased retrospective electronic medical record review of health care practitioner encounters to determine LEST in overweight/obese (body mass index≥25) patients between ages 2 and 18 years in our outpatient clinics. Intervention activities included lectures to staff and residents, fliers distributed to providers, monthly email reminders, and computer stickers placed on all terminals. From both phases, samples of simple random samples were drawn from the selected electronic medical records and reviewed for LEST screening; after intervention from this pool of patients, a random sample was chosen for LEST rate analysis. LEST rates were calculated per 100 patient encounters.Results: We screened 2,979 and 2,634 pre and postintervention pediatric encounters from which we obtained a simple random sample of patients for LEST analysis. Overall of the 264 preintervention patients, 65 (24.4%) patients received LEST translating to 24/100 encounters. Of the 65 who received screening, 53 (81%) were classified as overweight/obese. Screening rate was higher for overweight/obese patients (32/100 encounters), when compared with normal weight patients’ crude OR 3.8 (11/100 encounters; 95% CI: 1.9–7.6, P

Osteogenesis imperfecta can be commonly mistaken for child abuse because of similar pattern of injuries. AA is a 3-week-old baby who presented to our emergency department with excessive crying. Skeletal survey revealed subacute spiral fracture of the right humerus, right posterior eighth and ninth ribs, acute fracture of the left femur, bowing of tibia and femur, and osteopenia. Subsequent geneticist examination and genetic testing noted blue sclera and heterozygosity for a variant of COL1A gene.

1. Izaskun Melania Iglesias, MD, MBA* 2. Alexander Fernandez* 3. Eduardo Smith-Singares, MD, FACS* 4. Kenneth Soyemi, MD, MPH, MBA* 5. Rosibell Arcia, MD* 1. *John H Stroger Hospital of Cook County, Chicago, IL. A 12-year-old girl presents to the emergency department with a 5-hour history of abdominal pain, nausea, and vomiting. The pain is periumbilical, radiating to the left lower quadrant, colicky, and rated 5/10 at the onset. In the emergency department, she rates the pain as 8/10 and has two nonbloody, nonbilious episodes of emesis. She denies any fever, constipation, or diarrhea. She is not sexually active, had menarche 2 months ago, and had her last menstrual period end 3 days ago. She denies dysmenorrhea. She has no allergies, hospitalizations, or previous surgeries. On physical examination, the patient is in severe distress, afebrile, and pale. Mucous membranes are moist, and the girl has hyperpigmented perioral and intraoral mucosal lesions, freckles on her face, and macules on the tips of the fingers. Her abdomen is soft, nondistended, and tender to palpation on bilateral lower quadrants with rebound tenderness. No masses are palpable and the Rovsing sign is positive. …

A 6-month-old boy presents with a temperature of 38.9°C and barking cough of 3 days’ duration as well as a rash over his body for 1 day. On physical examination, his temperature is 37.5°C, respiratory rate is 28 breaths/min, and blood pressure is 87/52 mm Hg. He appears nontoxic and has a barking cough, injected conjunctiva with whitish discharge, dry lips, mild inspiratory stridor, a blanching erythematous maculopapular rash on his trunk and extremities, and small cervical lymph nodes. The rest of his physical findings are normal. His Hgb is 12.8 g/dL (128 g/L), WBC count is 11.7×103/mcL (11.7×109/L) with 75% neutrophils and 23% lymphocytes, and platelet count is 515×103/mcL (515×109/L). His stridor is considered to be due to viral croup, and he is treated with intramuscular (IM) dexamethasone and nebulized racemic epinephrine. A lateral neck radiograph reveals widening of the retropharyngeal space (Fig. 1), and he is started on clindamycin. CT scan of the neck reveals a right retropharyngeal abscess (Fig. 2). He continues to have high spiking fevers and experiences stridor at rest. He is started on IM dexamethasone every 6 hours, and his fever subsides the following day. Figure 1. Lateral neck radiograph showing widening of the retropharyngeal space. Figure 2. CT scan of the neck showing a right retropharyngeal abscess (arrow). On hospital day 6, the corticosteroids are stopped, but the fever returns the following day. Two days later, an erythematous maculopapular rash reappears, and the child’s lips are dry and cracked. On day 10, repeat CT scan shows that the retropharyngeal abscess has resolved. An additional imaging study reveals the cause of his symptoms. A 3-month-old previously healthy girl presents to the ED with a 1-day history of a blistering rash. Her parents noted an erythematous area on her occiput after …