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Autopsy and Medicine
November 9, 1998

Case of the Month: Death and Distraction

Kim A. Collins, MD; C. Jeff Lee, DO; Randy Hanzlick, MD; et al and the Autopsy Committee of the College of American Pathologists
Arch Intern Med. 1998;158(20):2183-2184. doi:10.1001/archinte.158.20.2183

A 13-YEAR-OLD black boy was living in a foster home. According to the foster mother, he fell in the tub and sustained an injury to the right hip. The boy was described as being sarcastic, belligerent, and a poor historian during the examination at the hospital. He also accused the physician of trying to play with him. The results of radiography of the right hip were negative for fracture. His temperature was 37.6°C; pulse rate, 82 beats/min; respiration rate, 20/min; and blood pressure, 110/62 mm Hg. The examination was not prolonged, and the boy was sent home with the diagnosis of a right-hip contusion. Ibuprofen was prescribed for pain. Two days later at a follow-up visit, the boy denied any problems other than some tenderness in the right hip. The foster mother reported a productive cough in the child. Again, he was difficult to examine and had a nonchalant attitude. Examination revealed the following: temperature, 38.7°C; pulse rate, 108 beats/min; and respiration rate, 24/min. A complete blood cell count showed a white blood cell count of 0.01 × 109/L (11.7/µL). Lungs were described as clear by auscultation. He was described as in no acute distress and sent home with a diagnosis of right-hip strain. Two and a half days later, he was found dead in bed. An autopsy was requested by the coroner, who had been notified of the death pursuant to state death investigation statutes.

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