This is a patient with a prior medical history of prematurity and asthma. She was admitted to the hospital for community-acquired pneumonia. According to the available medical records, the patient was ill for about 4 days with a cough, wheezing, and fever at home. Initially she was seen in her pediatrician's office and due to her history of asthma was then taken to the Emergency Department (ED) for evaluation. The expert's determination of medical necessity is upheld.
This child did not have a significantly elevated leukocyte count on her initial evaluation; her white blood cell count (WBC) was 9.9. The child had multiple documented physical exams that stated that she was in no acute distress and was hemodynamically stable. She did not have any increase significant increase in respiratory rate suggesting SIRS. The concerns for SIRS as the justification of the admission, are not reflected in the decision-making documented by the treating physicians. There was never any documented hypoxia on physical exam.