Acute rheumatic fever and poststreptococcal reactive arthritis: diagnostic and treatment practices of pediatric subspecialists in Canada.

OBJECTIVE: We conducted a survey of pediatric specialists in rheumatology, cardiology, and infectious diseases to ascertain present Canadian clinical practice with respect to diagnosis and treatment of acute rheumatic fever (ARF) and poststreptococcal reactive arthritis (PSReA), and to determine what variables influence the decision for or against prophylaxis in these cases. METHODS: A questionnaire comprising 6 clinical case scenarios of acute arthritis occurring after recent streptococcal pharyngitis was sent to members of the Canadian Pediatric Rheumatology Association, and to heads of divisions of pediatric cardiology and pediatric infectious diseases at the 16 university affiliated centers across Canada. RESULTS: There is considerable variability with respect to diagnosis in cases of ReA following group A streptococcal (GAS) infection both within and across specialties. There is extensive variability regarding the decision to provide prophylaxis in cases designated as ARF or PSReA. Findings indicated that physicians are most comfortable prescribing antibiotic prophylaxis in the presence of clear cardiac risk and are less inclined to such intervention for patients diagnosed with PSReA. When prophylaxis was recommended for cases of PSReA, the majority of respondents prescribed longer term courses of antibiotics. CONCLUSION: The lack of observed consistency in diagnosis and treatment in cases of reactive arthritis post-GAS infection likely reflects the lack of universally accepted criteria for diagnosis of PSReA and insufficient longterm data regarding carditis risk within this population. There is a need for clear definitions and treatment guidelines to allow greater consistency in clinical practice across pediatric specialties.

Identifying depressed and suicidal adolescents in a teen health clinic.

PURPOSE: This study examined the 6-month prevalence of depression and suicidal probability among new referrals to an adolescent health clinic. METHODS: All subjects (n = 104) completed the Beck Depression Inventory (BDI) and the Suicide Probability Scale (SPS) prior to being seen by a physician and were categorized according to presenting problem (physical complaints only, psychological complaints only, and physical and psychological complaints combined). RESULTS: Fifty-nine percent of the sample was depressed with 21% falling in the moderate range and 21% falling within the severe range of depression. Almost 23% of the sample demonstrated significant suicidal probability. The BDI and SPS were highly correlated (r = .73, p < .001) and 22% of the sample met criteria for both moderate to severe depression and suicidal probability. A significantly greater proportion of patients presenting with physical and psychological complaints combined (60%) met BDI criteria for depression than was found for the other two groups. Suicidal probability was most prevalent in patients presenting with psychological complaints only (26%) and moderate to severe depression and significant suicidal probability also coexisted to a greater extent within this group (26%). CONCLUSIONS: Results suggest that depression and suicidal probability represent significant mental health problems within the adolescent clinic and the identification of high-risk individuals can be achieved through comprehensive screening practices.