Pediatric vasitis: A rare complication of epididymitis.

Vasitis represents an inflammation of the vas deferens. This is a rare entity seen mostly in adult males following local surgery (e.g., vasectomy, hernia repair). Children with groin masses have a wide differential diagnosis. We describe a child with a groin mass following epididymitis diagnosed with vasitis and review the known literature regarding diagnostic tools and treatment. Vasitis in children, although rare, can be seen as a complication of epididymitis.

Use of time from fever onset improves the diagnostic accuracy of C-reactive protein in identifying bacterial infections.

OBJECTIVE: To determine whether the input of time from fever onset will change the accuracy of C-reactive protein (CRP) in diagnosing bacterial infections in febrile children. STUDY DESIGN: We performed a prospective observational study on febrile children presenting to the emergency department. The diagnostic performance of CRP at different time points from fever onset was compared using a receiver operating characteristic (ROC) curve. RESULTS: Among 373 patients included, 103 (28%) had bacterial infection. The optimal cut-off for CRP suggesting bacterial infection changed with time from fever onset: 6 mg/dL for >12-24 h of fever; 10.7 and 12.6 mg/dL at >24-48 and >48 h of fever, respectively. The input of time from fever onset improved the area under the ROC curve from 0.83 (95% CI 0.78 to 0.88) for CRP overall to 0.87 (95% CI 0.77 to 0.96) and 0.90 (95% CI 0.84 to 0.97) at >24-48 and >48 h of fever, respectively. Duration of fever mostly affected the ability of CRP to correctly rule out bacterial infections. CRP level of 2 mg/dL obtained at ≤24 h of fever corresponds with a post-test probability for bacterial infection of 10%, whereas the same value obtained >24 h of fever reduces the risk to 2%. CONCLUSIONS: Clinicians should apply different CRP cut-off values depending on whether they are trying to rule in or rule out bacterial infection, but also depending on fever duration at the time of CRP testing.

Chest radiography of acute paediatric lower respiratory infections: experience versus interobserver variation.

AIM: To determine radiological and clinical chest radiographs (CRs) interpretation agreement in children with acute respiratory disease (ARD) versus clinical experience in multiple observers. METHODS: Chest radiographs obtained in 70 consecutive children at the emergency department in 2010-2011 for ARD were reviewed. They were interpreted by 1-10 paediatric residents, three board-certified paediatricians (BCPs), three paediatric pulmonologists and one paediatric radiologist. Chest radiographs were analysed for presence of 10 radiological features and five diagnoses. A short clinical and laboratory context was given. Each child was given a clinical decision. Statistical analysis was by Fleiss' kappa for multiple observers. RESULTS: Kappas by selected major diagnostic features and by observer experience were expressed relative to diagnosis by paediatric radiologist. Best agreements were for pleural effusion and pneumonia and worst for normal X-ray, hyperinflation and atelectasis. Years of experience were influential. Antibiotics for pneumonia diagnosed by radiologist would not have been prescribed in 23% of cases by residents, 25% by BCPs and 15% by pulmonologists. CONCLUSION: In ARD in children, there is little interobserver agreement, especially among residents, which may impact on major clinical decision. There is a need to systematically train physicians in CRs reading.