Solving the curious case of Henry Ott Pediatric ER specialists on call, on screen

Heather Ott took her five-year-old son Henry to a clinic last September when he ran a fever. The provider believed a virus was to blame – a common diagnosis, especially when school starts. But then Henry developed rashes and bloodshot eyes.

“By the sixth day, he didn’t want me to pick him up because he was hurting so bad,” Heather recalls. When Henry complained of neck pain, Heather took him to urgent care at GRHS.

The urgent care provider ordered lab work, but results were negative. Something wasn’t right, so she recommended that Henry see an emergency room physician before the Otts went home. Mitch Palmer, MD, examined Henry in the ER.

“When a child has fevers and neck pain, we consider bacterial meningitis,” says Dr. Palmer. “But I also suspected Henry could have an uncommon illness, so I contacted Children’s Hospital in Minneapolis.”

Before last fall, Dr. Palmer would have used a phone to describe Henry’s symptoms. But Henry was the first patient to use GRHS’ 24-7 telemedicine link to the pediatric ER at Children’s Hospital.

Specialists on call – and on screen

As little Henry lay in his ER bed in Glencoe, a computer on a cart next to him quickly connected to an ER specialist at Children’s. She appeared on screen to talk with Dr. Palmer, Henry and Heather. From her location in Minneapolis, the physician used a high-definition camera to take a closer look at Henry – zooming in on his eyes, rashes and other presenting symptoms. That was helpful because Henry’s illness could not be detected by a specific test –only by a collection of symptoms.

The diagnosis? Kawasaki disease.

Dr. Palmer had never diagnosed nor even seen a case of Kawasaki disease in 17 years of practicing emergency medicine. Less than 20,000 cases occur in the U.S. per year. Up to 90 percent are in kids younger than age 5, so Children’s Hospital’s much larger volume of pediatric cases means its providers are more familiar with the rare illness.

Kawasaki disease causes inflamed blood vessels – the reason for Henry’s bloodshot eyes. Sometimes the coronary arteries are affected, which can lead to serious heart problems later in life. That’s why prompt treatment is vital – preferably within the first 10 days of illness.

Skipped to the head of the line

Henry’s family drove him to Children’s that night. They were delighted to learn transfers from GRHS are direct admissions and skipped an ER exam because of the telemedicine consultation. “That saved us time and money,” says Heather.

Children’s clinicians performed an echocardiogram of Henry’s heart and started 12 hours of intravenous immunoglobulin treatment. He also was given aspirin, something normally not given to children his age, but often used to treat Kawasaki disease.

The next morning, “he looked like a different kid,” Heather says. “His eyes

Five-year-old Henry Ott’s consultation with a pediatric emergency medicine specialist at Minneapolis Children’s Hospital took place in the GRHS ER via this telemedicine station with high-definition camera. His mom, Heather Ott (right), and the GRHS ER team were with him. were white again and his fever had gone.”

Children’s kept Henry one more day for observation. He will receive a series of echocardiograms to monitor his heart, but 95 percent of children who are promptly treated will avoid future heart problems due to the disease.

Convenient answers

The telemedicine consults provide immediate local access to pediatric specialists that otherwise would require an ambulance or long car ride.

Dr. Palmer says that knowing when to consult experts is a vital skill for health care providers. “A consultant physician can glean invaluable information from ‘laying eyes’ on a patient that just can’t be obtained from a conversation.”

Visit grhsonline.org/telemedicine for more information.