This case takes learners through the steps involved in the practice of evidence-based medicine. It uses a case of potential heart disease in a child with Trisomy 21 to help learners work through a diagnostic problem.
Your task is to work through the following case, answering the questions that follow each portion of the scenario. You can use a blank sheet of paper or the attached file to write out your answers. You will get more out of the exercise if you actually write out your answers.
Part 1 (Friday AM in the Newborn Nursery)
You are DS. It’s Friday morning and you’re making rounds in the newborn nursery. You are due to see Mr. and Mrs. Beal, whose baby was born yesterday. The baby was diagnosed prenatally with Trisomy 21. You are going to discharge the baby today. Before going in to talk with the family, you discuss the discharge plans with the attending pediatrician, Dr. Keep.
Dr. Keep: So how is baby Beal?
DS: She’s doing well, feeding well. Mom and Dad are doing okay, given her diagnosis and all. My exam today is totally normal. I think she’s okay to go home.
Dr. Keep: You know, kids with Trisomy 21 are at increased risk of congenital heart disease. How was her cardiac exam today?
DS: Totally normal. She has normal 4-limb blood pressures, normal pulses, no murmur or anything.
Dr. Keep: So does that reassure you? How common is heart disease in kids with this condition?
DS: It seems reassuring. I mean, I did a really careful exam. I would think that with a normal cardiac exam, the chance of having heart disease is practically zero.
Dr. Keep: Hmmm. It seems like the answer to this question would be important to the Beals. If you were to pose this as a clinical question that you could answer using the literature, what would that question be?
Write out the answers to the following questions on your sheet. Then go onto the next page.
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Last updated: April 3, 2000