Searching for an Emergency Department Method for Detecting Serious Bacterial Infection in Children

From the AAP:

There is not a pediatrician who has not pondered why we do not have a method for detecting serious bacterial infection (SBI) that is 100% sensitive and specific for predicting who is at high risk and low risk for such infection. While numerous studies have tried to tackle this question and have moved us closer to “diagnostic nirvana,” we are not there yet; although, new diagnostic tools continue to be proposed to get closer to the diagnostic accuracy we all strive for.  For example, new biomarkers are an example of potential diagnostic predictive tools that may, in combination with the usual predictors (clinical exam, white blood count, urinalysis, spinal fluid) make predicting risk for SBI even more accurate.

Rural hospitals face a new threat

From the Register (editorial):

The hospitals are also struggling with doctor shortages, disproportionately higher rates of uninsured patients and lower patient-employment rates. They are also having a hard time improving their bottom line because of the growing amount of non-reimbursed bad debt caused by patients who simply can’t afford the cost of their care.

Some critical access hospitals, including those in Iowa, are surviving, if not exactly flourishing, because they’re based in states that elected to expand Medicaid coverage under the Affordable Care Act, ensuring that more patients have the coverage needed to pay their hospital bills. Unfortunately, the Congressional Budget Office expects that some states will consider dropping Medicaid expansion as the federal money that pays for much of it evaporates with the possible dismantling of the Affordable Care Act.

This would not only threaten rural Americans’ access to life-saving, emergency medical care, it would cripple the ability of rural communities to retain residents and attract new industries.