Pediatric Examination Research Articles

295 children’s bronchoscopy due to choking episode with suspected foreign body in the of pediatric ent department – analysis of choking risk factors

Introduction. Aspiration of foreign body by children is a common cause of respiratory failure and an indication for urgent bronchoscopy. This procedure under general anesthesia is very difficult, stressful and dangerous in children due to their small diameter of the respiratory tract with a symptom of dyspnea. The tendency to put everything in to the mouth for cognitive purposes, incomplete dentition, immature swallowing mechanism are all the factors of high risk of choking episodes in very young children. Over the years still has been discussions on how to limit the number of bronchoscopies performed in children. Aim.The authors of this analysis try to find an answer to the question of whether and which way the number of bronchoscopy of the lower respiratory tract in children can be limited. Material and methods. 295 children underwent a bronchoscopy in the Department of Pediatric Otolaryngology of the Medical University of Warsaw in 2015-2020 after an episode of choking with suspected foreign body of the lower respiratory tract. The procedure was done after an appropriate pediatric examination and X-ray of the chest. In the analysis, particular attention was paid to the type of foreign bodies, pathology in clinical examination and tests. Results. 295 patients underwent rigid bronchoscopy under general anestesia. The indications for this procedure was single episode of choking. All children presented some patology in physical examination or on chest X-ray. Only in 142 (48%) patients a various foreign bodies were found and removed. That were 110 (77.5%) organic and 32 (22.5%) inorganic foreign bodies. Among all 142 cases only 9 (6%) were visible on X-ray. Peanuts and seeds were the most common foreign bodies, identified in 81% patients. The median age was 2 years. Conclusions. There are not characteristic symptoms of foreign body in respiratory tract in clinical investigation after single episode of choking. The suspicion of aspiration is still the main indicates for urgent bronchoscopy in children. It seems that the number of performed bronchoscopies could be reduced by prevention. Extensive education for young parents should be providing to inform them about choking hazard. We should pay special attention to them not to give small hard organic food to their children; especially nuts and grains. Parents’ attention should also be paid to toys, which for toddlers must be free of small, moving parts. Also companies producing food and toys for children should be obliged to place information on the risk of chocking on their products.

Pediatric Emergencies: A Practical, Clinical Guide by Emily Rose MD. New York: Oxford University Press, 2020; 722 pp; $130.00 (paperback)

The stated aim of Pediatric Emergencies: A Practical, Clinical Guide is to be, “more clinically focused than a traditional textbook but more comprehensive than a typical clinical guide.” By and large, the book successfully achieves this aim. Each chapter gets straight to the important points about common or cannot-miss pediatric emergency diagnoses. For example, there are useful discussions about the classic and atypical presentations of endocrine disorders, including pituitary apoplexy, thyroid storm, and Cushing’s syndrome (pp. 334–350). The chapter sections are succinct and focus on need-to-know information for emergency providers. The book is organized by organ system, with additional pertinent chapters on procedures, sedation, vascular access, and medicolegal issues in pediatric emergency medicine. Each chapter introduces the unique pathophysiology or diagnostic considerations of pediatric patients, then delves into the most common and pertinent diagnoses and their management. Key points and pitfalls are helpful features of each section, which naturally catch the reader’s attention in bullet point format. In general, the layout of the book allows for quick review of a topic and, for educators, preparation for easy clinical teaching pearls. In this era of FOAMed, including podcasts and blog posts, any book must be easy to read, have relevant visual stimuli, and must not force the reader to get bogged down in the weeds. As mentioned previously, the key points and pitfalls are helpful in this regard, as are the many treatment algorithms (p. 346, diabetic ketoacidosis treatment) and clinical guidelines (p. 31, brief resolved unexplained event, or BRUE, formerly known as ALTE). The sections focusing on how to best perform specific pediatric examinations are also essential (p. 457, pediatric eye exam tips) and, as any provider caring for children should know, must be peppered with playtime. Any textbook in a medical subspecialty warrants authorship from leaders in the field and representation from across the country, both of which Dr. Rose and her team achieved. Furthermore, the art of pediatric emergency medicine involves the tips and tricks that make practice easier, such as the simple mnemonic for remembering which laryngoscope blade should be used to intubate a mid–elementary aged child (Appendix 3). For those who are curious, this helpful mnemonic is, “use a 2 at [age] 2, and 3 in 3rd grade.” In several chapters, there are excellent pictures and tables to illustrate key points, such as the “Procedural Sedation and Pain Management” chapter. In fact, kudos to the pediatric model who bravely sat for the many facial and dental block illustrations (p. 596). A true benefit to many portions of this book are comparisons of how pediatric complaints contrast with adult presentations, for example, how pediatric versus adult physiology affects outcomes in thoracoabdominal trauma (p. 405). Often in the emergency medical care of adults, we rely upon laboratory and imaging studies to answer our clinical questions. There is a valid argument for this, as pathology is often more sinister in adults than children. The true test of emergency providers is the ability to appropriately choose when pediatric complaints warrant more than a comprehensive physical examination and shared decision making with the parent/guardian. As such, there are several topics that highlight this important consideration; it would have been helpful to see more focus on this in every chapter. Future iterations could also address minor oversights, such as a legend for the easy-to-read vaccination schedule (Appendix 5) and improvements in some of the photos. The authors intended for this book to neatly fill the niche between traditional textbook and clinical guide. Many chapters use a case-based format to achieve this aim, whereas others skew more toward a traditional, yet truncated, textbook version. Regardless, there is a useful niche for this book when other pediatric emergency texts fit more clearly in the wordy, traditional realm. The target audience is general emergency providers, including physicians, trainees, and advanced practice providers. To that end, it seems that most emergency physicians would be interested in exactly this. Overall, Pediatric Emergencies: A Practical, Clinical Guide is an excellent on-shift reference for all things pediatric emergency medicine, whether for community attendings who want to brush up on the latest in BRUE management or for educators looking for a visual reference to illustrate their teaching point on interpreting pediatric chest radiographs. It is also a great text for students or trainees who are looking to increase their knowledge by homing in on the most essential aspects of diagnosis and management. I highly recommend Pediatric Emergencies: A Practical, Clinical Guide for emergency physicians and other providers.

Fifteen-minute consultation: Apparent vaginal bleeding in the pre-pubertal girl

A parent or carer’s observation of blood in a child’s nappy or underwear can be quite alarming for both parent and child and may indicate vaginal bleeding. At first glance,...

Sedation Rate Reduction in Paediatric Renal Nuclear Medicine Examinations: Consequences of a Targeted Audit.

Background: Nuclear medicine investigations are essential diagnostic tools in paediatric urology. Child-orientated examination techniques and the avoidance of sedation or anaesthesia vary in different institutions. We aimed at evaluating child friendly measures in our department to identify the potential for improvement. Based on these data, we changed the standards regarding the sedation policy and consequently re-evaluated sedation rates. Methods: Four-hundred thirty-five consecutive investigations were evaluated regarding the need for sedation, outcome and patient satisfaction at our department. After the revision of our department standards, we re-evaluated 159 examinations. Statistical analysis was performed with JUMBO (Java-supported Münsterian biometrical platform). Results: Eighty-six percent (60/70) would agree to perform an investigation under identical conditions again. Seventy-seven percent (17/22) of eligible patients >5 years of age felt good during the investigation. By changing our sedation policy, we could reduce the sedation rate from 27.1% to 7.5% (p < 0.0001; OR 0.219 95% CI 0.111–0.423). Conclusion: The evaluation of child friendly examination protocols demonstrated high reliability and patient satisfaction using situational sedation with a relatively high proportion of patients being sedated. Through protocol adaption with clear age limits, individual indication and education of staff, as well as the use of optimized sedatives, the need for sedation could be further reduced whilst maintaining a high patient satisfaction.

TEKNIK PEMERIKSAAN BARIUM ENEMA PADA PASIEN ANAK DENGAN DENGAN KLINIS MORBUS HIRSCHPRUNG

Background: Based on differences in theory with the field that focuses on 4 different factors, namely the use of Iodine contrast material which should be BaSO4 (Bontrager, 2012), the use of Nelaton Catheter which should be a Polycatheter or Barium set (Bontrager, 2012) and (Ballinger, 2012), the addition of Prone position on plain abdominal photo examination should only be in the Supine position, using the Oblique R / L position (Optional) which should only be plain AP photo, AP contrast, Lateral contrast, and AP Post evacuation (Bontrager, 2012)&#x0D; Methods: Qualitative descriptive, which is carried out by means of observation, interviews, literature review and documentation (photo taking), research This was carried out for 6 months with a total population of ten patients and a sample of three patients with details of one primary sample and two secondary samples.&#x0D; Results: Image analysis, and comparison of Barium Enema Pediatric examination techniques in the territory with the field obtained from interviews with three radiographers and three radiologists.&#x0D; Conclusions : The pediatric Barium enema examination technique is performed under fluoroscopy control with the ratio of contrast material to the liquid is 1: 4 and 1: 2 for Hirschprung Suspect and 2: 3 for clinical Morbus Hirschprung on Colostomy as well as AP and PA projection shooting techniques for preliminary photos, AP supine with contrast, lateral to contrast, and photographs 24 hours after examination (post evacuation).&#x0D;

Siblings Are Also at Risk for Abuse.

Approximately 9 of every 1000 children in the United States are identified as victims of maltreatment, including neglect, physical abuse, emotional abuse, or sexual abuse.1 However, many cases of maltreatment are not identified,2 which has severe consequences for affected children.3 Although it is important to evaluate any child at risk for abuse, identifying risk can be challenging. In this issue of Pediatrics, Kisely et al4 evaluated whether siblings of children with suspected abuse are themselves at increased risk. These researchers followed a large cohort of sibling pairs in Australia. They found a 60-fold increase in abuse reports for siblings of children who had themselves been reported as abused previously. The risk was even greater when the mother was <20 years of age. The type of abuse (eg, physical, sexual, neglect) was often concordant between sibling pairs.Sibling risk has previously been studied but not on the scale of this new publication. Lindberg et al5 collected data from almost 3000 children who were evaluated for physical abuse. Contacts, including siblings or others in the same environment (including day care) of physically abused children were at significantly increased risk for injury.5 This risk was even higher among twins.Armed with the knowledge of the increased risk to siblings, medical providers and child welfare professionals should advocate for evaluations of these children at high risk. In cases of physical abuse, the evaluation by Lindberg et al5 included head imaging for contacts aged <6 months or those with mental status changes, skeletal surveys for contacts aged <2 years, and physical examinations for all contacts aged <5 years. This evaluation by Lindberg’s team parallels the recommended evaluation for any child when there is concern for physical abuse, although it may be reasonable to perform head imaging on any infant at high risk for abuse, such as siblings.6,7 To conduct a thorough examination, providers should familiarize themselves with injuries that are most specific for abuse, such as facial bruises and frenular injuries.8Siblings of sexual abuse victims should also be evaluated. Although the American Academy of Pediatrics policy statement on sexual abuse does not mention siblings or contacts, the National Children’s Alliance (the accrediting body for children’s advocacy centers) recognizes that siblings and other household contacts of abuse victims are themselves at risk.9,10 Evaluations for possible sexual abuse typically involve a forensic interview (if a child is developmentally capable) and a sexual abuse evaluation performed by a provider with training in pediatric sexual abuse examinations.9,10 Children’s advocacy centers are present throughout the country to assist in these evaluations of both suspected sexual abuse victims and their siblings.10The finding that children are at increased risk for maltreatment if they live with a young mother can help inform prevention efforts. For example, some home visitation programs, such as Nurse-Family Partnership, which works with first-time mothers in poverty, can help target the risks seen with young mothers, including lack of support and lack of education, and may have some benefit to prevent physical abuse.11As pediatricians, we are advocates for children, so our evaluation for suspected child abuse or neglect should include asking about the presence of siblings or other children in that environment. Subsequently, we should follow-up to ensure that any siblings are appropriately evaluated for abuse themselves.

Kariesprävention im Säuglings- und frühen Kindesalter

BackgroundIn the past different recommendations for caries prevention through fluoride application in infancy and early childhood (0–6 years old) existed in Germany; however, if different recommendations coexist it leads to confusion among health professionals and parents/caregivers, to a lower acceptance of the recommendations and, consequently, to insufficient implementation.MethodsJoint recommendations were formulated in a multistage process, coordinated by the Healthy Start—Young Family Network (Netzwerk Gesund ins Leben). Representatives of the relevant German medical and scientific societies, professional associations and specialized institutions participated in the process and reviewed the scientific evidence. Feasibility and accessibility were considered, also with respect to families with an increased risk of caries.RecommendationsFrom birth to tooth eruption infants should receive a supplement with 400–500 IU vitamin D and 0.25 mg fluoride. After tooth eruption, the child should gently and gradually be introduced to tooth brushing. A choice should be made between continuing systemic fluoride application (400–500 IU vitamin D and 0.25 mg fluoride) or using a toothpaste with 1000 ppm fluoride (up to 2 times 0.125 g/day, the size of a grain of rice); vitamin D supplementation is continued until the second summer in the child’s life. During the first 12 months, infants fed exclusively or predominantly on formula food are given a vitamin D supplement without fluoride if the fluoride content of the water used to prepare the formula contains ≥ 0.3 mg fluoride/l. In this case the daily amount of fluoride toothpaste should also be reduced. From 12 months on tooth brushing twice a day with a toothpaste containing fluoride (1000 ppm fluoride) is recommended, first with a small amount of toothpaste (each time up to 0.125 g, the size of a grain of rice) and then with a larger amount of toothpaste from 24 months (each time up to 0.25 g, pea-sized). To avoid excessive fluoride intake, the correct amount of toothpaste is essential. Education and advice on caries prevention and on how to put the recommendations into practice should be provided during pediatric and dental examinations as well as within the National Dental Group Prevention Program.

Evaluation of digital otoscopy in pediatric patients: A prospective randomized controlled clinical trial

Acute otitis media is often misdiagnosed. Pediatric trainees learn otoscopy from supervisors who cannot concurrently view the eardrum. Digital, smartphone otoscopes show promise to improve the visibility and learning due to a concurrent view by trainees and supervisors. We aimed to determine whether use of digital otoscopes improved accuracy of the ear exams between medical trainees and their supervisors, compared to using traditional otoscopes. Secondarily, we evaluated whether the use of digital otoscopes reduced the number of repeat ear examinations by supervisors, changed the trainee's confidence in their exam findings, and led to differences in the rate of antibiotics prescribed. This study was a randomized controlled trial comparing use of a digital otoscope to a traditional otoscope, in a pediatric emergency department and primary care clinic in an academic tertiary care children's center. We used a modified validated image-based grading scale to compare accuracy of the ear exam between trainees and supervisors. Surveys documented modified OMgrade scores, frequency of supervisor exams, trainee confidence on a 5-point Likert scale, and antibiotic prescriptions. Inter-rater agreement of trainees and supervisors, the number of supervisor confirmatory examinations performed, trainee confidence, and antibiotic prescription rates were evaluated. Amongst 188 children, 375 ears were examined by 85 trainees and 22 supervisors. The digital otoscope was utilized in 92 (48.9%) exams and 96 (51.1%) used the traditional otoscope. Accuracy of ear exam findings between trainees and supervisors improved by 11.2% (95% CI: 1.5, 21.8%, p = 0.033) using the Cellscope Oto (74.8%, 95% CI: 67.3, 82.1%) compared to the traditional otoscope (63.5%, 95% CI: 56.7, 70.4%). Fewer repeat supervisor exams were performed in the digital otoscope group (27.2%) vs. the traditional otoscope group (97.9%) (p < 0.001). There was no difference in mean trainee confidence in their examination (p = 0.955) or antibiotic prescription rates when using digital versus traditional otoscopes (p = 0.071). Utilization of a digital otoscope resulted in increased accuracy of the ear exam between trainees and supervisors, and fewer total number of examinations performed on a given child. Compared to a traditional otoscope, a digital otoscope may be a more efficient and effective diagnostic tool.

Long-term neurodevelopmental outcome after prenatal exposure to maternal hematological malignancies with or without cytotoxic treatment

ABSTRACT Data on the long-term neurodevelopmental outcomes of children exposed to hematological maternal cancer with or without treatment during pregnancy are lacking. A total of 57 children, of whom 33 males and 24 females, prenatally exposed to hematological malignancies and its treatment, were invited for neuropsychological and physical examinations at 18 months, 36 months, 6, 9, 12, 15 and 18 years of age. Oncological, obstetrical, neonatal and follow-up data of these children were collected. Parents were asked to complete questionnaires on their child’s general health, school performances, social situation, behavioral development, executive functioning, and if their child receives supportive care. Non-Hodgkin lymphoma was diagnosed in 35.1%, Hodgkin lymphoma in 28.1%, acute myeloid leukemia in 15.8%, chronic myeloid leukemia in 12.3%, and acute lymphoblastic leukemia in 8.8%. Cognitive development at a median age of 10.7 years was within the normal range. In subgroup analyses of children in early childhood, the gestational age at birth was correlated with the cognitive outcome at a median age of 1.7 years. Scores for language development, intelligence, attention, memory and behavior, as well as clinical neurological and general pediatric examinations were within normal ranges. In subgroup analyses, the need for supportive care in the child was associated with the loss of the mother. Prenatal exposure to hematological maternal malignancies with or without treatment did not affect the neurodevelopment of the child in the long term. Yet, caution is indicated and surveillance of the emotional development of the child is needed, especially when the mother is deceased to cancer.

Evaluation of patient organ doses from kilovoltage cone-beam CT imaging in radiation therapy.

Currently, CBCT system is an indispensable component of radiation therapy units. Because of that, it is important in treatment planning and diagnosis. CBCT is also an crucial tool for patient positioning and verification in image-guided radiation therapy (IGRT). Therefore, it is critical to investigate the patient organ doses arising from CBCT imaging. The purpose of this study is to evaluate patient organ doses and effective dose to patients from three different protocols of Elekta Synergy XVI system for kV CBCT imaging examinations in image guided radiation therapy. Organ dose measurements were done with thermoluminescent dosimeters in Alderson RA NDO male phantom for head & neck (H&N), chest and pelvis protocols of the Elekta Synergy XVI kV CBCT system. From the measured organ dose, effective dose to patients were calculated according to the International Commission on Radiological Protection 103 report recommendations. For H&N, chest and pelvis scans, the organ doses were in the range of 0.03-3.43 mGy, 6.04-22.94 mGy and 2.5-25.28 mGy, respectively. The calculated effective doses were 0.25 mSv, 5.56 mSv and 4.72 mSv, respectively. The obtained results were consistent with the most published studies in the literature. Although the doses to patient organs from the kV CBCT system were relatively low when compared with the prescribed treatment dose, the amount of delivered dose should be monitored and recorded carefully in order to avoid secondary cancer risk, especially in pediatric examinations.

EFFECTIVE DOSE IN PEDIATRIC INTERVENTIONAL CARDIOLOGY.

The aim of this study was to estimate the effective doses (EDs) to children undergoing pediatric interventional cardiology examinations in hospitals of St.-Petersburg, to calculate associated dose conversion coefficients (DCCs) and to investigate their dependence of different parameters of the various procedures. Basic parameters of pediatric cardiology examinations and patient doses were studied in three main pediatric city hospitals. More than 300 examinations were under consideration. The technical, geometrical and dosimetric parameters, as well as patients' parameters, for each individual procedure were collected. All cardiac examinations were divided into five age groups (newborn, 1, 5, 10 and 15 y old). The EDs and the corresponding DCCs from the dose-area product to ED were calculated using PCXMC 2.0 software and based on the collected data. The study included the evaluation of the relations between the DCCs, patient age and parameters of examinations. The results of the study indicated significant dependence of the DCCs on the patients' age and the beam quality. The DCCs for the newborns and 15-year old groups differed by a factor of 10. The maximum estimated ED of 26mSv was found in the newborn age group.

Comparison of medical student performance in summative undergraduate paediatric examinations and a clinician-designed minimum accepted competency (MAC) assessment

BackgroundIt is recognised that newly qualified doctors feel unprepared in many areas of their daily practice and that there is a gap between what students learn during medical school and their clinical responsibilities early in their postgraduate career. This study aimed to assess if undergraduate students and junior paediatric doctors met a Minimum Accepted Competency (MAC) of knowledge.MethodsThe knowledge of undergraduates and junior paediatric doctors was quantitatively assessed by their performance on a 30-item examination (the MAC examination). The items within this examination were designed by non-academic consultants to test ‘must-know’ knowledge for starting work in paediatrics. The performance of the students was compared with their official university examination results and with the performance of the junior doctors.ResultsFor the undergraduate student cohort (n = 366) the mean examination score achieved was 45.9%. For the junior doctor cohort (n = 58) the mean examination score achieved was significantly higher, 64.2% (p < 0.01). 68% of undergraduate students attained the pass mark for the MAC examination whilst a significantly higher proportion, 97%, passed their official university examination (p < 0.01). A Spearman’s rank co-efficient showed a moderate but statistically significant positive correlation between students results in their official university examinations and their score in the MAC examination.ConclusionThis work demonstrates a disparity between both student and junior doctor levels of knowledge with consultant expectations from an examination based on what front-line paediatricians determined as “must-know” standards. This study demonstrates the importance of involvement of end-users and future supervisors in undergraduate teaching.

Effect of music on pediatric endoscopic examinations: a randomized controlled trial

Background and study aims The primary objective was to measure the effect of music as an adjunct to sedation in patient anxiety levels during pediatric endoscopic examinations. Patients and methods We performed a single-blind randomized controlled trial comparing music with no music in children aged 2 to 18 years. Anxiety was measured using the Modified Yale Preoperative Anxiety Scale (m-YPAS) and the Visual Analog Anxiety Scale (VAS-anxiety). Patient perception of pain was evaluated with the Wong-Baker Faces Pain Rating Scale (WBFPRS). Patient experience, family satisfaction, and endoscopist perception of difficulty were evaluated. Sedative doses were recorded. Results A total of 51 children were randomized to the experimental group and 49 children to the control group. The mean ages were 10.5 years and 12.3 years, respectively. There were 63 % female subjects with no differences between groups. Overall, there were 85 upper endoscopies and 15 colonoscopies. In the recovery unit, the experimental group had lower average m-YPAS scores (mean score 27.7 vs 34.7; P < 0.001), a higher proportion of them had low m-YPAS scores (80 % vs 49 % P < 0.001), had lower VAS-anxiety scores [mean score 0.55 vs 1.57 ( P = 0.003)], and had lower WBFPRS scores [mean score 2.7 vs 1.3 ( P = 0.001)]. There were no statistically significant differences found in the amount of standard sedation given to the groups, nor in additional sedation administered. In the experimental group, the patient-reported experience was significantly better. Conclusions The study results show that music reduces anxiety and pain associated with endoscopic procedures in children. It also facilitates these procedures and improves patient satisfaction.

Estimating Organ Doses from Pediatric Cerebral Computed Tomography Using the WAZA-ARI Web-Based Calculator

Background: The use of computed tomography (CT) device has increased in the past few decades in Japan. Dose optimization is strongly required in pediatric CT examinations, since there is concern that an unreasonably excessive medical radiation exposure might increase the risk of brain cancer and leukemia. To accelerate the process of dose optimization, continual assessment of the dose levels in actual hospitals and medical facilities is necessary. This study presents organ dose estimation using pediatric cerebral CT scans in the Kyushu region, Japan in 2012 and the web-based calculator, WAZA-ARI (https://waza-ari.nirs.qst.go.jp). Materials and Methods: We collected actual patient information and CT scan parameters from hospitals and medical facilities with more than 200 beds that perform pediatric CT in the Kyushu region, Japan through a questionnaire survey. To estimate the actual organ dose (brain dose, bone marrow dose, thyroid dose, lens dose), we divided the pediatric population into five age groups (0, 1, 5, 10, 15) based on body size, and inputted CT scan parameters into WAZA- ARI. Results and Discussion: Organ doses for each age group were obtained using WAZA-ARI. The brain dose, thyroid dose, and lens dose were the highest in the Age 0 group among the age groups, and the bone marrow and thyroid doses tended to decrease with increasing age groups. All organ doses showed differences among facilities, and this tendency was remarkable in the young group, especially in the Age 0 group. This study confirmed a difference of more than 10- fold in organ doses depending on the facility and CT scan parameters, even when the same CT device was used in the same age group. Conclusion: This study indicated that organ doses varied widely by age group, and also suggested that CT scan parameters are not optimized for children in some hospitals and medical facilities.

Congenital Hip Dislocation with a Genu Recurvatum in Togo: A Case Report

Introduction: CHD is a condition, which is frequent in pediatrics in the Caucasian population, remains rare in the Black population, and exceptional in sub-Saharan Africa. The Patient: We report this first Togolese case of bilateral congenital dislocation of the hip associated with genu recurvatum observed in a newborn received on the second day of life. The Primary Diagnoses, Interventions, and Outcomes: The pediatric examination had noted extension of lower limbs. The thighs were in adduction with a stiff bilateral genu recurvatum. The abduction of the thighs on the pelvis was considerably limited. The Barlow and Ortolani maneuvers showed a protrusion. There was also a camptodactyly of the thumbs and a cleft palate. The rest of the examination was normal. Ultrasound of the hip showed a bilateral congenital dislocation of the hip with an estimated acetabular fundus of 7 mm on both the right and left sides. Ultrasound and radiography of the knees were normal. Conclusion: Clinical examination at birth is the key step in diagnosis of congenital hip dislocation. In situations where diagnosis is difficult, ultrasound is of capital importance. Treatment is in the majority of cases orthopedic.

Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students

ObjectivesThe authors aim to evaluate the “point-of-care” transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. MethodsThe students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. ResultsThe cognitive evaluation (maximum score=10 points) before and after training increased in group A from 4,0±1,04 to 7,5±1,2 (p<0.001) and, 6 months later, to 6,5±1,16 (p<0.003); in group B from 3,8±1,24 to 8,8±1,01 (p<0.001) and, 6 months later, to 8,46±0,91 (p<0.001); and in group C from 6,0±0,75 to 9,0±0,75 (p<0.001) and, 6 months later, to 8,8±0,77 (p<0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. ConclusionCognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.

Performance of overnight on-call radiology residents in interpreting unenhanced abdominopelvic magnetic resonance imaging studies performed for pediatric right lower quadrant abdominal pain

BackgroundAbdominopelvic magnetic resonance imaging (MRI) is increasingly being used to evaluate children with abdominal pain suspected of having acute appendicitis. At our institution, these examinations are preliminarily interpreted by radiology residents, especially when performed after hours.ObjectiveTo determine the accuracy of preliminary reports rendered by radiology residents in this setting.Materials and methodsThree hundred seventy-seven pediatric abdominopelvic MRI examinations were included. The preliminary (resident) and final (attending) radiology reports were coded as diagnosing acute appendicitis or no acute appendicitis. The concordance between resident and attending radiologist interpretations was calculated. Additionally, both resident and attending reports were compared to available surgical pathology or clinical follow-up data.ResultsOverall concordance rate for the diagnosis of acute appendicitis was 97.1%. Concordance for verified cases of acute appendicitis was 93.4%. Concordance rates did not differ by residents’ postgraduate year levels. When compared against surgical pathology or clinical follow-up data, residents demonstrated 91.2% sensitivity and 97.6% specificity. There was no statistically significant difference in the sensitivity or specificity of resident or attending radiologist interpretations.ConclusionRadiology residents demonstrate high concordance with attending pediatric radiologists in their interpretations of pediatric abdominopelvic MRI for acute appendicitis. The diagnostic performances of residents and attendings were comparable.

Neural classification of Norwegian radiology reports: using NLP to detect findings in CT-scans of children

BackgroundWith a motivation of quality assurance, machine learning techniques were trained to classify Norwegian radiology reports of paediatric CT examinations according to their description of abnormal findings.Methods13.506 reports from CT-scans of children, 1000 reports from CT scan of adults and 1000 reports from X-ray examination of adults were classified as positive or negative by a radiologist, according to the presence of abnormal findings. Inter-rater reliability was evaluated by comparison with a clinician’s classifications of 500 reports. Test–retest reliability of the radiologist was performed on the same 500 reports. A convolutional neural network model (CNN), a bidirectional recurrent neural network model (bi-LSTM) and a support vector machine model (SVM) were trained on a random selection of the children’s data set. Models were evaluated on the remaining CT-children reports and the adult data sets.ResultsTest–retest reliability: Cohen’s Kappa = 0.86 and F1 = 0.919. Inter-rater reliability: Kappa = 0.80 and F1 = 0.885. Model performances on the Children-CT data were as follows. CNN: (AUC = 0.981, F1 = 0.930), bi-LSTM: (AUC = 0.978, F1 = 0.927), SVM: (AUC = 0.975, F1 = 0.912). On the adult data sets, the models had AUC around 0.95 and F1 around 0.91.ConclusionsThe models performed close to perfectly on its defined domain, and also performed convincingly on reports pertaining to a different patient group and a different modality. The models were deemed suitable for classifying radiology reports for future quality assurance purposes, where the fraction of the examinations with abnormal findings for different sub-groups of patients is a parameter of interest.

Computed tomography based measurements to evaluate lung density and lung growth after congenital diaphragmatic hernia

Emphysema-like-change of lung is one aspect of lung morbidity in children after congenital diaphragmatic hernia (CDH). This study aims to evaluate if the extent of reduced lung density can be quantified through pediatric chest CT examinations, if side differences are present and if emphysema-like tissue is more prominent after CDH than in controls. Thirty-seven chest CT scans of CDH patients (mean age 4.5 ± 4.0 years) were analyzed semi-automatically and compared to an age-matched control group. Emphysema-like-change was defined as areas of lung density lower than − 950 HU in percentage (low attenuating volume, LAV). A p-value lower than 0.05 was regarded as statistically significant. Hypoattenuating lung tissue was more frequently present in the ipsilateral lung than the contralateral side (LAV 12.6% vs. 5.7%; p < 0.0001). While neither ipsilateral nor contralateral lung volume differed between CDH and control (p > 0.05), LAV in ipsilateral (p = 0.0002), but not in contralateral lung (p = 0.54), was higher in CDH than control. It is feasible to quantify emphysema-like-change in pediatric patients after CDH. In the ipsilateral lung, low-density areas are much more frequently present both in comparison to contralateral and to controls. Especially the ratio of LAV ipsilateral/contralateral seems promising as a quantitative parameter in the follow-up after CDH.

Supporting Children Experiencing a Pediatric-Sexual Assault Forensic Examination: Preparation for and Perceptions of the Role of the Child Life Specialist

To help minimize negative outcomes, child life specialists can provide psychosocial care to patients undergoing a pediatric sexual assault forensic examination (P-SAFE). This exploratory study used a survey to examine child life specialists’ perspectives on their preparation for and role in P-SAFEs. Participants reported their main duties with this population include procedure support, play, and building rapport. The benefits of having child life involved in P-SAFEs were noted as decreasing re-traumatization, increasing cooperation, increasing coping, and decreasing stress and anxiety. Participants reported that most child life services were provided in preparation for the exam and during the exam. The services utilized were preparation, play, and distraction to help patients cope. Results indicated child life specialists felt valued by the multidisciplinary team, especially for their role in procedure support. Lastly, child life specialists reported training for this role occurring most often through informal on the job training. In summary, child life specialists acknowledged the stressors associated with a P-SAFE and perceived their role as beneficial in minimizing such stressors. Health care facilities that provide P-SAFEs should further consider the benefits of child life services to these patients and advocate for their services during P-SAFEs.