Hospitalist Fails To Diagnose Meningitis In Autistic Child

Case Overview

This case involves an autistic 11-year-old girl who presented to the pediatric emergency room with high fever, cough, and fatigue. She was diagnosed with pneumonia, given a 10-day course of amoxicillin, and discharged. The child’s symptoms worsened over the course of the antibiotic treatment and she returned to the hospital. The child was found to have fluid buildup in her lungs. She was given intravenous antibiotics and an additional 10-day course of antibiotics. She was eventually discharged from the hospital but expired at home a few days later. An autopsy revealed the child expired from bacterial meningitis. An expert hospitalist pediatrician was sought to review the records and opine on the standard of care.

Questions to the Pediatrics expert and their responses

How does the treatment and decision to discharge a non-verbal, autistic child differ from that in a normal child?

The diagnostic and therapeutic approach to a non-verbal, autistic child is very different from the care of an otherwise healthy child. Caring for a non-verbal patient requires detailed attention to nonverbal cues, highly astute observational skills, attention to subtle clinical and historical data and a focus on all members of the team including ancillary services and family who might be able to contribute valuable data to the patient's course. The care of a child who is non-verbal and autistic is even more complicated as they are often unwilling to participate in physical exams and occasionally violently refuse physical exams. In these instances, the above is true in addition to a significant reliance on care providers who can help guide exams, calm patients and inform how to best approach these patients.

How is success/failure of treatment monitored in a patient like this, in terms of repeat labs and imaging?

While we attempt to limit unnecessary labs and images in pediatric patients, we often trend labs and images in critically ill children who are admitted to the hospital as a way of monitoring their clinical course. We rely on this data even more in a non-verbal child as it can contribute essential data that we may not otherwise be able to obtain through verbal communication and physical exams.

About the expert

This highly qualified expert has nearly a decade of professional experience in the field of pediatrics and pediatric hospital medicine. She earned her BA in psychology from Bates College in Maine, before earning a certificate in pre-medical sciences from Columbia University. She also earned her MPH in epidemiology from Columbia University. She then went on to earn her MD from the Pritzker School of Medicine at the University of Chicago. She completed a residency in pediatrics at the University of Chicago, eventually serving as chief resident in her final two years of residency. She also completed a fellowship in the University of Chicago MERITS (Medical Education Research Innovation, Teaching and Scholarship) program. She is certified by the American Board of Pediatrics in general pediatrics and pediatric hospital medicine. She has published over a dozen peer-reviewed articles and delivered numerous presentations on various topics in her field. She has previously served as a pediatric hospitalist at NorthShore University Health Systems in Chicago. She has also previously served as a clinical associate and associate clerkship director at an elite medical school in Illinois, where she currently holds the positions of assistant professor of pediatrics, and co-clerkship director.

E-156120

Specialties:

Pediatrics