408 FLUOROSCOPY UTILIZATION IN PEDIATRIC ENDOSCOPY

Abstract

Fluoroscopy in children requires judicious usage given the risks of ionizing radiation. Fluoroscopy may be utilized during both gastrointestinal (GI; e.g. colonoscopy) and pulmonary (bronchoscopy) endoscopy; however, limited data is available regarding usage and documentation during these pediatric procedures. We completed a retrospective chart review of patients who underwent GI and pulmonary endoscopy with fluoroscopic guidance at a large children’s hospital from January 2016 to September 2017. Patient and procedure characteristics were systematically captured, including fluoroscopy dosage, time, and documentation completion. Statistical analysis, including ANOVA and Student’s t-test, was performed using IBM SPSS 24.0 software. A total of 221 endoscopies (130 GI, 91 pulmonary) were performed among 179 unique patients. GI patient characteristics are listed in Table 1. The most common GI procedure was intestinal dilation (43.1%), followed by endoscopic retrograde cholangiopancreatography (34.6%) and motility catheter placement (21.5%). All pulmonary procedures were bronchoscopies with transbronchial biopsies. Fluoroscopy time was available for 98.5% of GI cases and all bronchoscopies (Table 2). GI fluoroscopy dosage was present in medical records for 66.2% of cases. Of the GI procedures with available data, 82.9% used continuous fluoroscopy exposure, while 17.1% used both continuous and pulsed modes. All pulmonary cases utilized pulsed exposure. Among 8 GI physicians, there was significant inter-provider variation in fluoroscopy time and dose during endoscopic dilation (p<0.004). There was no difference in fluoroscopy time among the 4 pulmonary physicians included in this analysis (p=0.408). Over the 21-month study duration, GI and pulmonary procedures demonstrated a downtrend in fluoroscopy time (Spearman’s correlation: r=0.47 and 0.39; p<0.01). Physician documentation of procedural details included fluoroscopy usage in 97% of both GI and pulmonary cases. Duration of fluoroscopy exposure was reported in GI notes in 55.4% of procedures. Only one case reported an immediate adverse event related to fluoroscopy (aspiration of contrast). Fluoroscopy dosage and duration varied for the same procedure type amongst GI providers. Fluoroscopy time was longer during GI vs. pulmonary cases, though both groups exhibited a decrease in fluoroscopy time over the study duration. Exposure time and dosage are important quality metrics, and should be matched with diagnostic yield from these procedures. Given the variation amongst providers and potential ability to decrease fluoroscopic usage over time, further research into the utilization of fluoroscopy in pediatric endoscopy is integral to improving quality of care and safety.Table 1Gastrointestinal Patient CharacteristicsMeanMedianRangeSex63% maleAge (years)9.180.4-20Weight (kg)38.226.95.4-128.5BSA (m2)1.110.3-2.3ASA2.521-4(BSA=body surface area, ASA=American Society of Anesthesiologists Physical Status classification) Open table in a new tab Table 2Fluoroscopy Usage During EndoscopyGastroenterologyPulmonologyCombinedDose (mGy)Time (sec)Time (sec)Time (sec)Mean11.868.4*33.9*54.1Median556.62135.4Range0.3-130.91.2-412.47.7-133.41.2-412.4Quartile Percentiles25th1.322.3141675th10.799.34877*p Open table in a new tab