Pediatric interventional radiology workforce survey summary.
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Humans↗
Biomedical subjects
Kristy D Seidel
Publications and source records attributed to Kristy D Seidel.
A comparison of a needle-free injection system for local anesthesia versus EMLA for intravenous catheter insertion in the pediatric patient.
Placement of IV catheters is a painful and stressful procedure for children. J-Tip is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip versus eutectic mixture of local anesthetics (EMLA) to facilitate IV cannulation and provide adequate analgesia before IV placement. Children 7-19 years of age (n = 116) were randomized to receive 0.25 mL of 1% buffered lidocaine with J-Tip (n = 57) or 2.5 g of EMLA (n = 59) before IV cannulation. Measurements of success of cannulation (number of attempts for IV placement) and pain (0-10 visual analog scale) at application of local anesthetic and at cannulation were performed. There was a significant (P = 0.0001) difference in pain ratings during IV cannulation between EMLA (median = 3) and the J-Tip (median = 0). Eighty-four percent of patients reported no pain at the time of J-Tip lidocaine application compared to 61% in the EMLA group at the time of dressing removal (P = 0.004). We did not find differences in the number of attempts for IV cannulation. J-Tip application of 1% buffered lidocaine before IV cannulation is not painful and has better anesthetic effectiveness compared with EMLA.
Administration, Topical↗
Do antireflux operations decrease the rate of reflux-related hospitalizations in children?
OBJECTIVE: Gastroesophageal reflux disease is extremely common in the pediatric population, and antireflux procedures are performed with increasing frequency. The objective of this study was to determine whether pediatric antireflux procedures are associated with a decreased rate of reflux-related hospitalizations. METHODS: A study was conducted of pediatric patients who were undergoing antireflux procedures using data that were derived from the Washington State Comprehensive Hospital Abstract Reporting System and Vital Records. Patients were identified by a search of all records (1987-2001) for procedure codes that pertained to antireflux procedures in patients who were younger than 19 years. The number of hospitalizations for and rates of reflux-related events per patient-year before and after an antireflux procedure was calculated, and factors that were associated with higher antireflux procedure rates were examined. RESULTS: A total of 1142 patients underwent antireflux procedures. The rate of reflux-related events declined sharply with age both before and after an antireflux procedure. The cohort was divided into 3 groups on the basis of age at first antireflux procedure (<1 year, 1-3 years, or 4-19 years), and the calculations of incidence rate ratios before to after an antireflux procedure were done within the same age strata. Results suggest an overall benefit of antireflux procedures in young children. For antireflux procedures that were performed in children who were older than 4 years, the benefit is less clear. Developmental delay was significantly associated with higher rates of reflux-related events among patients who underwent an antireflux procedure after age 4. CONCLUSIONS: The rate of reflux-related events was lower after an antireflux operation for children who underwent an antireflux procedure before age 4. Older children, however, were hospitalized at equal rates before and after an antireflux procedure, and older children with developmental delay were hospitalized at greater rates after an antireflux procedure. These findings highlight the need to clarify the subjective and objective indications for antireflux procedures in infants and children.
Adolescent↗
Liver histology and alanine aminotransferase levels in children and adults with chronic hepatitis C infection.
BACKGROUND: Chronic hepatitis C is often a mild disease in children, but whether this is related to younger age or shorter duration of infection is unclear. Histologic severity has been shown to correlate with duration of infection regardless of age. OBJECTIVES: We compared histologic findings in children and adults with chronic hepatitis C while controlling for sex, duration of infection, hepatitis C virus (HCV)-RNA level, and genotype. METHODS: Twenty-one children and 52 adults whose infection was less than 20 years in duration and who had undergone a liver biopsy were included. Two blinded liver pathologists reviewed the liver biopsies and scored inflammatory activity and fibrosis using the modified Knodell scoring system. RESULTS: The groups were the same with respect to HCV-RNA level (P=0.8), and genotype (P=0.6) but differed in duration of disease (P=0.01) and sex composition (P=0.005). Covariate analysis showed no influence of genotype, duration of infection, or HCV-RNA level on outcome. In controlling for sex, children had significantly milder liver disease and alanine aminotransferase (ALT) elevations. CONCLUSIONS: With equal duration of infection, HCV-RNA level, and genotype, children have lower serum ALT levels and less severe liver disease than adults infected with HCV.
Adolescent↗
Detection and quantification of human immunodeficiency virus type 1 p24 antigen in dried whole blood and plasma on filter paper stored under various conditions.
The quantification of human immunodeficiency virus type 1 (HIV-1) by an assay measuring heat-dissociated (HD) p24 antigen (Ag) in specimens of whole blood and plasma stored on filter paper, and of plasma stored in tubes, was compared to HIV-1 RNA plasma levels determined by real-time reverse transcription (RT)-PCR. The stability of p24 Ag on filter paper under conditions simulating specimen transport was also evaluated. The HD p24 Ag in both plasma and whole-blood specimens stored on filter paper correlated with plasma HIV-1 RNA levels (Spearman rank rho = 0.74 [P < 0.0001] and rho = 0.56 [P = 0.0001], respectively). The sensitivity of the HD p24 Ag assay was similar when plasma and whole blood on filter paper were contrasted to the real-time RT-PCR assay (80% versus 82.5% and 78.6% versus 83.3%, respectively). However, while the specificity of the HD p24 Ag assay of plasma on filter paper was 100%, the specificity was diminished in whole-blood specimens. The storage of specimens on filter paper for 2 weeks at 37 degrees C, 24 degrees C, or 0 degrees C did not alter the detection or quantification of HD p24 Ag. These results suggest that transport and storage of plasma on filter paper and quantification of HD p24 Ag may be a reliable method for HIV-1 load monitoring.
Filtration↗
Cranial suture simulator for ultrasound diagnosis of craniosynostosis.
BACKGROUND: In evaluating the effectiveness of ultrasound as a screening tool for craniosynostosis it was discovered that sonologists and sonographers needed more experience scanning and visualizing cranial sutures on ultrasound. OBJECTIVE: To create an ultrasound simulator to train radiologists and technologists to locate and recognize patent and fused cranial sutures in children. MATERIALS AND METHODS: The hypoechoic appearance of patent sutures was simulated by cutting lines into life-sized plastic doll heads and filling them with a commercial hypoechogenic material. Fused hyperechoic sutures were simulated by not cutting into the hard plastic region of a suture. The simulator's teaching value was evaluated on three radiology residents and three fellows. Subjects performed pre-training scans on unknown simulators, received feedback and an opportunity to scan a training simulator, and then performed post-training scans on random unknown simulators. Accuracy was recorded as percentage of correctly demonstrated sutures. RESULTS: The suture simulator reproduces the sonographic appearance of patent and fused cranial sutures. Accuracy of acquisition, interpretation, and overall diagnosis increased from 64 to 91%, 79 to 91%, 61 to 97%, respectively, between pre and post training scans. CONCLUSION: An ultrasound simulator can reproduce the appearance of patent and fused cranial sutures in children and can be used to train radiologists and technologists in the performance of a screening protocol.
Cranial Sutures↗
Persistence of human immunodeficiency virus type 1 subtype B DNA in dried-blood samples on FTA filter paper.
The stability of human immunodeficiency virus type 1 (HIV-1) DNA in whole blood collected on filter paper (FTA Card) was evaluated. After >4 years of storage at room temperature in the dark our qualitative assay detected virus at a rate similar to that of our initial test (58 of 60, 97%; P = 0.16), suggesting long-term HIV-1 DNA stability.
Acquired Immunodeficiency Syndrome↗
Ultrasound screening of the lambdoid suture in the child with posterior plagiocephaly.
BACKGROUND: The child with posterior plagiocephaly may have positional molding or unilateral lambdoid synostosis. Molding responds to conservative treatment, lambdoid synostosis requires surgical reconstruction. CT is diagnostic, but uses ionizing radiation, may need sedation, and the incidence of lambdoid fusion is only 2-3%. OBJECTIVE: The purpose of this prospective study was to evaluate ultrasound as a screening test of lambdoid sutural patency using CT as the reference standard. MATERIALS AND METHODS: In total, 41 children having head CT examinations were enrolled over 6 months. Of those, 29 were referred for abnormal head shape and suspected synostosis, of whom two had lambdoid fusion; 12 were referred for indications not related to head shape and found to have a normal study. Ultrasound scanning and interpretation of the lambdoid sutures was performed blinded to the CT reference standard. The lambdoid suture was read as patent or fused if a hypoechoic gap could or could not be seen between the hyperechoic calvarial bones, respectively. RESULTS: The mean sensitivity and specificity of ultrasound in distinguishing a patent from fused lambdoid suture by three blinded pediatric radiologists was 100% and 89%, respectively. CONCLUSIONS: Sonography of the lambdoid sutures shows excellent preliminary promise as a screening test of lambdoid sutural patency.
Cranial Sutures↗
A randomized, clinical trial of oral midazolam plus placebo versus oral midazolam plus oral transmucosal fentanyl for sedation during laceration repair.
OBJECTIVE: To determine whether a combination of oral transmucosal fentanyl (Fentanyl Oralet, Abbott Laboratories, North Chicago, IL) plus oral midazolam has an acceptable safety profile and is more effective than oral midazolam alone for sedation during laceration repair in a pediatric emergency department (ED). METHODS: Randomized, double-blind, placebo-controlled, clinical trial. Patients between 2 and 8 years of age who weighed >10 kg and presented to the ED with a laceration in need of repair under sedation were eligible for inclusion. All patients received oral midazolam (0.5 mg/kg; maximum dose 10 mg) and either fentanyl (5-10 microg/kg) or placebo in oralet form. Data collected every 5 minutes included the following: heart rate, oxygen saturation, respiratory rate, pain as measured on a Children's Hospital of Eastern Ontario Pain Score (CHEOPS) scale (range: 4-13), and an activity scale (range: 1-5). Effectiveness of sedation was measured by CHEOPS and activity scores compared between the treatment groups. RESULTS: Fifty-one patients were randomized to receive oral midazolam plus fentanyl (N = 28) or oral midazolam plus placebo (N = 23). Age, weight, gender, or baseline pain and activity scores did not differ between the 2 groups. Seven patients in the fentanyl group vomited compared with 0 patients in the placebo group. Three patients in the fentanyl group and no patients in the placebo group had brief oxygen saturation below 93% on room air. The mean pain score within 5 minutes of the start of the procedure did not differ between the 2 groups (fentanyl group, 9.4 versus placebo group, 8.8). Mean activity scores within 5 minutes of the start of the procedure were also similar (fentanyl group, 4.3 versus placebo group, 4.3). CONCLUSIONS: The addition of oral transmucosal fentanyl to oral midazolam did not improve pain or activity scores in pediatric patients given sedation for laceration repair. Patients who received Fentanyl Oralet suffered significantly more side effects despite the relatively low doses administered in this study. Oral transmucosal fentanyl should not be used for procedural sedation in the ED.
Adjuvants, Anesthesia↗
Rapid computed tomography technique to measure ventricular volumes in the child with suspected ventriculoperitoneal shunt failure I. Validation of technique with a dynamic phantom.
OBJECTIVES: Assessment of ventricular volume change is critical and can be difficult in the child with suspected shunt failure. Objective techniques described to measure ventricular volumes have used limited anatomic sampling or have been computationally intensive. Phantoms used to evaluate these techniques have used static volumes. The purpose of this study was to construct a computed tomography (CT) phantom to simulate changing ventricular volumes and to evaluate a new program to measure volumes. METHODS: The phantom is 5 Foley catheters embedded in gelatin. The balloons were filled and then scanned at 15-mL increments from 0-300 mL. The program measures the voxels of specified density within a larger volume created by applying a region of interest to a stacked volume. Calculated volumes and percent changes were compared with actual volumes and percent changes. RESULTS: Calculated volumes were consistently 7%-9% (mean: -7.8%) less than actual injected volumes across the entire 0- to 300-mL range. For true changes between -50% and +50%, all calculated changes were within +/-2.5% points of true percent change; for true changes between +50% and +100%, all calculated changes were within +/-5% points of true percent change. CONCLUSIONS: A dynamic CT phantom simulating changing ventricular volumes can be constructed from readily available materials. A new volumetric program accurately measures ventricular volumes and percent change from baseline across a wide range of volumes.
Cerebral Ventricles↗
Rapid computed tomography technique to measure ventricular volumes in the child with suspected ventriculoperitoneal shunt failure II. Clinical application.
OBJECTIVES: Assessment of ventricular volume change is critical in the child with suspected shunt failure. Minimal increases may represent high pressures in the child with reduced ventricular compliance but are difficult to detect subjectively. Objective techniques described limit anatomic sampling and are time intensive. The purpose of this study was to develop a rapid technique to measure ventricular volumes in children with suspected shunt failure. METHODS: Ventricular volumes were calculated in 12 children with baseline and emergent computed tomography scans performed for suspected shunt failure. Volumes and percent interval changes were correlated with clinical course. Two observers performed the volume analysis blinded to the clinical information; 1 observer performed the analysis twice. Time to perform the analysis was recorded for 5 studies. RESULTS: The intraobserver and interobserver correlation coefficients were 0.99 and 0.96/0.97, respectively. The mean time to perform the analysis was 2 minutes 42 seconds. Median percent change in patients with and without shunt obstruction was +50% (range: +24%-+367%) and +2% (range: -22%-+36%), respectively. Among patients subjectively read as having stable ventricular sizes, volume changes of -11% to +32% were calculated. CONCLUSIONS: The technique has excellent intra- and interobserver correlation and is rapidly performed. The range of percent volume changes between patients with and without shunt malfunction overlaps. Subjective assessment of ventricular changes is significantly less sensitive than the volume calculation technique. The technique may be most useful in patients with decreased ventricular compliance in whom small interval changes may represent large pressure increases.
Adolescent↗