Pediatrics: A Case-Based Review

Book Title: Pediatrics: A Case-Based Review

Author: Michaela Kreckmann (Translator: Gertrude Champe)

Publication Information: Stuttgart, Germany,Thieme Publishers, 2019,* 297 pp., $64.99, paperback

* This is a 2019 English translation of the 2008 German second edition.

With family physicians seeing fewer kids, we need interesting, quick ways to maintain our knowledge of not-to-miss diagnoses. Unfortunately, quality pediatric case-based reviews are hard to find.

In this book, we finally have a case-based review of general pediatrics worthy of purchase by family medicine residents and academic family physicians teaching or overseeing pediatric aspects of curriculum. Highlights include densely informative educational pages with quality photos, focused on high-yield topics for family doctors. Drawbacks are that the English translation does not consistently include American evidence-based standards of care, and the book is a 2019 translation of a 2008 German publication, so some data is outdated. Regardless, this book and its accompanying eBook concisely present in-depth information on timeless pathophysiology for important presentations.

Michaela Kreckmann, MD, a private practice pediatrician in Saarbrucken, Germany, wrote this book for her medical students. In it, she catalogs 85 clinical cases from prematurity through adolescent mental health issues, using a well-structured, educational format. She selected pediatric cases representing the most relevant, essential learning for students and family physicians, with an emphasis on dangerous diagnoses primary care physicians shouldn’t miss. Cases span 17 systems, many with educational aspects in more than one system, realistically reflecting primary care practice. The book includes free access to the English eBook, via Thieme’s MedOne online portal.

The table of contents is searchable by presentation, system, or diagnosis. The “Cases” section includes each case and related questions with space to write answers. This is followed by an “Answers and Comments” section with several educational pages on each case. This presents a nuisance for readers who do not enjoy flipping from one section to another, but the identical eBook resolves that; with each case, the related questions, and then answers and comments for that case following one another. The eBook also includes photos formatted for easy transfer to PowerPoint for lecture purposes.

The greatest strength of this book is the quality of the “Answers and Comments” section. Each is practical with refreshingly informative data organized into concise illustrations, charts, and bullet points. Pathophysiology, rationale for clinical decisions, expected symptoms and potential complications with each diagnosis, next steps in care, and anticipated course are major strengths. Kreckmann expands on some cases to broaden learning on related topics. For example, comments on the newborn with brachial plexus paralysis after shoulder dystocia include practical descriptions of other common birth injuries.

The biggest limitation of this book is that, while many cases do mention important adaptations to US care and geography, there are several cases in which important differences are not mentioned. This is problematic because the US audience most likely to benefit from this book (providers with less pediatric experience) will also be less aware of which practice tips are not consistent with the American standards of care. Examples include a recommendation to use chloral hydrate for sedation (no longer available in the United States due to safety concerns) or a benzodiazepine and a bronchodilator in infants with bronchiolitis. Other differences include a recommendation to obtain an EEG for children with febrile seizures (not considered necessary in the United States), and lack of mention of American standards for preventive care. Cases where important geographic differences are appropriately described include CDC data references for cases on tuberculosis and tick-borne illness, and information on regions in the United States where various tick-borne infections are found. Additionally, some terminology differs from US practice. For example, the young child with abdominal pain due to intussusception has “invagination.” While initially the terminology differences are disorienting, they also add an element of international character.

In summary, this book is an excellent option for pediatric case review, but it does have limitations for US audiences that need to be taken into consideration. While perfect for German medical students, with excellent cases and detailed pathophysiology illustrations that make learning easy, the book’s utility for US students is diminished due to incomplete data on US standards of care. Perhaps the population that will find this work most valuable are educators with a solid pediatric knowledge base looking for interesting teaching cases. Family medicine faculty and residents will find it helpful in preparing didactics and stimulating small group discussion, and should have the awareness of local practice standards, or at least the informatics skills to verify local recommendations. Administrative faculty overseeing family medicine residency curriculum would also be wise to use this book to ensure their curriculum includes the most important not-to-miss diagnoses pertinent to family medicine.