• A CBC is one piece of information that can be helpful in determining whether a serious illness exists, particularly an infection. It is not automatically required in a child of this age with a fever, even with an elevated heart rate and respiratory rate.
• Rhinorrhea may be a symptom of upper respiratory infection, including viral infection.
• It is generally accepted that fever alone can cause an elevated respiratory rate as well as an elevated heart rate.
• The literature does not support CT prior to LP without suspicion of a space-occupying lesion, and the radiation exposure most likely outweighs any benefit in the pediatric population.

When applicable, ACEP policies apply to all members, and that includes the Expert Witness Guidelines, as the policy itself makes clear. Apparently, the witness either changed his mind about this or contradicted his testimony by subsequently resigning his ACEP membership, possibly to avoid sanction by the College. The consensus of the Standard of Care Review Panel was that the physicians treating the patient in this case met the standard of care.

Dr. Pattavina is an emergency physician at St. Joseph Hospital in Bangor, Maine, and immediate past President of the Maine Medical Association.