Linear scleroderma is a form of localized scleroderma that primarily affects the pediatric population. When it occurs on the scalp or forehead, it is termed "en coup de sabre". In the en coup de sabre subtype, many extracutaneous associations, mostly neurological, have been described. A patient with linear scleroderma en coup de sabre was noted to have ipsilateral brain cavernomas by magnetic resonance imaging. Using a worldwide pediatric rheumatology electronic list-serve, another patient with the same 2 conditions was identified. These two patients are reported in this study. Consideration of neuroimaging studies to disclose abnormal findings in patients with linear scleroderma en coup de sabre is important for potentially preventing and treating neurological manifestations associated with this condition.

With our improvement methodology, we successfully increased guideline-adherent evaluation for patients with provider concern for NAT. Education and electronic support at the point of care were key drivers for initial implementation.

BACKGROUND: Children discharged from the emergency department (ED) with community-acquired pneumonia (CAP) revisit for several reasons, including disease progression or treatment failure. Understanding factors associated with revisits may assist clinicians in preventing subsequent visits. METHODS: Children aged 3 months to 18 years with an International Classification of Diseases, Ninth Revision diagnosis of CAP between December 1, 2009 and April 31, 2013 were eligible. The primary outcome was a CAP-related ED visit or hospitalization within 30 days of the index visit. The secondary outcome was a CAP-related ED visit within 48 hours of discharge from the index visit. The association between clinical variables and an ED revisit for children with CAP was assessed by using multivariable logistic regression models. RESULTS: Of the 3304 index ED visits by patients with CAP, 148 (4.5%) revisited the ED. Children with complex chronic conditions (CCCs) were 2.23 times as likely to revisit the ED as those without a CCC (95% confidence interval: 1.29–3.86). Children admitted and those who received aminopenicillins at the index visit were less likely (63% and 49%, respectively) to revisit the ED (95% confidence interval: 0.24–0.56 and 0.30–0.85, respectively). CONCLUSIONS: Although children with CAP have a relatively low revisit rate to the ED, patients who received aminopenicillins at their index visit were statistically less likely to revisit when adjusting for markers of severity (eg, age, CCCs, and disposition at index visit). Clinical factors alone, however, may not be the only indicators of revisits, and additional factors may need to be considered in future studies.

Objectives: To identify predictors of physical abuse evaluation in infants younger than 6 months with visible injury and to determine the prevalence of occult fracture and intracranial hemorrhage in those evaluated.Methods: Infants 6.0 months or younger who presented with visible injury to a pediatric hospital-affiliated emergency department or urgent care between July 2013 and January 2017 were included. Potential predictors included sociodemographics, treatment site, provider, injury characteristics, and history. Outcome variables included completion of a radiographic skeletal survey and identification of fracture (suspected or occult) and intracranial hemorrhage.Results: Visible injury was identified in 378 infants, 47% of whom did not receive a skeletal survey. Of those with bruising, burns, or intraoral injuries, skeletal survey was less likely in patients 3 months or older, of black race, presenting to an urgent care or satellite location, evaluated by a nonpediatric emergency medicine-trained physician or nurse practitioner, or with a burn. Of these, 25% had an occult fracture, and 24% had intracranial hemorrhage. Occult fractures were also found in infants with apparently isolated abrasion/laceration (14%), subconjunctival hemorrhage (33%), and scalp hematoma/swelling (13%).Conclusions: About half of preambulatory infants with visible injury were not evaluated for physical abuse. Targeted education is recommended as provider experience and training influenced the likelihood of physical abuse evaluation. Occult fractures and intracranial hemorrhage were often found in infants presenting with seemingly isolated "minor" injuries. Physical abuse should be considered when any injury is identified in an infant younger than 6 months.