Gaume, M; Pietton, R; Vialle, R; Chaves, C; Langlais, T
Dans: Arch Pediatr, vol. 27, no. 6, p. 333–337, 2020, ISSN: 1769-664X.
@article{pmid32563619,
title = {Is daily walking distance affected in adolescent idiopathic scoliosis? An original prospective study using the pedometer on smartphones},
author = {M Gaume and R Pietton and R Vialle and C Chaves and T Langlais},
doi = {10.1016/j.arcped.2020.04.002},
issn = {1769-664X},
year = {2020},
date = {2020-08-01},
journal = {Arch Pediatr},
volume = {27},
number = {6},
pages = {333--337},
abstract = {BACKGROUND DATA: Little is known about daily walking distance levels, which accounts for approximately 80% of overall physical activity per day, in adolescents with idiopathic scoliosis (AIS).nnOBJECTIVE: The aim of this study was to assess the level of walking distance in AIS treated by bracing or not, comparing this activity with that of a control group. We used an original method based on smartphone pedometers for studying walking distance in everyday life.nnMETHODS: Nineteen AIS patients, aged 14.1 (13-17) years, and 25 asymptomatic patients, aged 12.9 (12-14) years were included prospectively. The 19 AIS cases comprised 9 untreated individuals and 10 with ongoing night brace treatment. The mean walking distance per day as estimated by the pedometer application on smartphones for 2 months was assessed. Weekly sports activities (hours per week) were also reported.nnRESULTS: During the first month, the mean walking distance was 2.58±0.65 km/day for control patients, 2.31±1.38 km/day for untreated AIS, and 3.65±0.72 km/day for AIS patients treated with a night brace. During the second month, the mean walking distance was 2.60±0.73 km/day for control patients, 2.40±1.41 km/day for untreated AIS, and 3.70±0.72 km/day for AIS patients treated with a night brace. Statistical analysis between groups showed a statistically significant difference with a higher level of daily walking distance in adolescents treated with a night brace compared with other groups.nnCONCLUSION: The pedometer on smartphones is a cost-effective and friendly tool to assess adolescents' level of walking distance. Our results indicate no restriction in terms of daily walking distance between adolescents without scoliosis and those with idiopathic scoliosis.nnLEVEL OF EVIDENCE: Level II.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND DATA: Little is known about daily walking distance levels, which accounts for approximately 80% of overall physical activity per day, in adolescents with idiopathic scoliosis (AIS).nnOBJECTIVE: The aim of this study was to assess the level of walking distance in AIS treated by bracing or not, comparing this activity with that of a control group. We used an original method based on smartphone pedometers for studying walking distance in everyday life.nnMETHODS: Nineteen AIS patients, aged 14.1 (13-17) years, and 25 asymptomatic patients, aged 12.9 (12-14) years were included prospectively. The 19 AIS cases comprised 9 untreated individuals and 10 with ongoing night brace treatment. The mean walking distance per day as estimated by the pedometer application on smartphones for 2 months was assessed. Weekly sports activities (hours per week) were also reported.nnRESULTS: During the first month, the mean walking distance was 2.58±0.65 km/day for control patients, 2.31±1.38 km/day for untreated AIS, and 3.65±0.72 km/day for AIS patients treated with a night brace. During the second month, the mean walking distance was 2.60±0.73 km/day for control patients, 2.40±1.41 km/day for untreated AIS, and 3.70±0.72 km/day for AIS patients treated with a night brace. Statistical analysis between groups showed a statistically significant difference with a higher level of daily walking distance in adolescents treated with a night brace compared with other groups.nnCONCLUSION: The pedometer on smartphones is a cost-effective and friendly tool to assess adolescents’ level of walking distance. Our results indicate no restriction in terms of daily walking distance between adolescents without scoliosis and those with idiopathic scoliosis.nnLEVEL OF EVIDENCE: Level II.
Ferrier, Clément; Khoshnood, Babak; Dhombres, Ferdinand; Randrianaivo, Hanitra; Perthus, Isabelle; Jouannic, Jean-Marie; Durand-Zaleski, Isabelle
Dans: BMJ Open, vol. 10, no. 7, p. e036566, 2020, ISSN: 2044-6055.
@article{pmid32690745,
title = {Cost and outcomes of the ultrasound screening program for birth defects over time: a population-based study in France},
author = {Clément Ferrier and Babak Khoshnood and Ferdinand Dhombres and Hanitra Randrianaivo and Isabelle Perthus and Jean-Marie Jouannic and Isabelle Durand-Zaleski},
doi = {10.1136/bmjopen-2019-036566},
issn = {2044-6055},
year = {2020},
date = {2020-07-01},
journal = {BMJ Open},
volume = {10},
number = {7},
pages = {e036566},
abstract = {OBJECTIVE: To assess trends in the average costs and effectiveness of the French ultrasound screening programme for birth defects.nnDESIGN: A population-based study.nnSETTING: National Public Health Insurance claim database.nnPARTICIPANTS: All pregnant women in the 'Echantillon Généraliste des Bénéficiaires', a permanent representative sample of 1/97 of the individuals covered by the French Health Insurance System.nnMAIN OUTCOMES MEASURES: Trends in the costs and in the average cost-effectiveness ratio (ACER) of the screening programme (in € per case detected antenatally), per year, between 2006 and 2014. incremental cost-effectiveness ratio (ICER) from 1 year to another were also estimated. We assessed costs related to the ultrasound screening programme of birth defects excluding the specific screening of Down's syndrome. The outcome for effectiveness was the prenatal detection rate of birth defects, assessed in a previous study. Linear and logistic regressions were used to analyse time trends.nnRESULTS: During the study period, there was a slight decrease in prenatal detection rates (from 58.2% in 2006 to 55.2% in 2014; p=0.015). The cost of ultrasound screening increased from €168 in 2006 to €258 per pregnancy in 2014 (p=0.001). We found a 61% increase in the ACER for ultrasound screening during the study period. ACERs increased from €9050 per case detected in 2006 to €14 580 per case detected in 2014 (p=0.001). ICERs had an erratic pattern, with a strong tendency to show that any increment in the cost of screening was highly cost ineffective.nnCONCLUSION: Even if the increase in costs may be partly justified, we observed a diminishing returns for costs associated with the prenatal ultrasound screening of birth defects, in France, between 2006 and 2014.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To assess trends in the average costs and effectiveness of the French ultrasound screening programme for birth defects.nnDESIGN: A population-based study.nnSETTING: National Public Health Insurance claim database.nnPARTICIPANTS: All pregnant women in the ‘Echantillon Généraliste des Bénéficiaires’, a permanent representative sample of 1/97 of the individuals covered by the French Health Insurance System.nnMAIN OUTCOMES MEASURES: Trends in the costs and in the average cost-effectiveness ratio (ACER) of the screening programme (in € per case detected antenatally), per year, between 2006 and 2014. incremental cost-effectiveness ratio (ICER) from 1 year to another were also estimated. We assessed costs related to the ultrasound screening programme of birth defects excluding the specific screening of Down’s syndrome. The outcome for effectiveness was the prenatal detection rate of birth defects, assessed in a previous study. Linear and logistic regressions were used to analyse time trends.nnRESULTS: During the study period, there was a slight decrease in prenatal detection rates (from 58.2% in 2006 to 55.2% in 2014; p=0.015). The cost of ultrasound screening increased from €168 in 2006 to €258 per pregnancy in 2014 (p=0.001). We found a 61% increase in the ACER for ultrasound screening during the study period. ACERs increased from €9050 per case detected in 2006 to €14 580 per case detected in 2014 (p=0.001). ICERs had an erratic pattern, with a strong tendency to show that any increment in the cost of screening was highly cost ineffective.nnCONCLUSION: Even if the increase in costs may be partly justified, we observed a diminishing returns for costs associated with the prenatal ultrasound screening of birth defects, in France, between 2006 and 2014.
Stepwise Management of Severe Thoracogenic Scoliosis in Burned Child
Langlais, Tristan; Pietton, Raphaël; Laurent, Romain; Cassier, Sophie; Constant, Isabelle; Mimoun, Maurice; Vialle, Raphaël
2020, ISSN: 1878-8769.
@misc{pmid31870815,
title = {Stepwise Management of Severe Thoracogenic Scoliosis in Burned Child},
author = {Tristan Langlais and Raphaël Pietton and Romain Laurent and Sophie Cassier and Isabelle Constant and Maurice Mimoun and Raphaël Vialle},
doi = {10.1016/j.wneu.2019.12.079},
issn = {1878-8769},
year = {2020},
date = {2020-04-01},
journal = {World Neurosurg},
volume = {136},
pages = {399--402.e2},
abstract = {BACKGROUND: Skin and soft tissue retraction secondary to burns of the trunk may induce severe and progressive thoracogenic spinal deformities in children. Its management is rarely described.nnCASE DESCRIPTION: Our study reports a case of severe thoracic scoliosis in a 13-year-old adolescent, secondary to soft tissue retraction due to trunk burn in early childhood. The Cobb angle of the scoliosis was 100 degrees. The 3-stage surgical strategy consisted of scar excision and skin graft in the first stage, halo gravity traction in the second stage, and posterior correction and fusion of the spine in the third and final stage. The postoperative course was satisfactory, and late follow-up at 1 year showed stable correction of the spine, with satisfactory coronal and sagittal balance and good healing of skin and soft tissues.nnDISCUSSION: While spinal deformities secondary to burns are rare, they require specific, sequential, and multidisciplinary medical and surgical management. Our surgical strategy was to treat skin and soft tissues retractions first and then address spinal deformity. We used halo-gravity traction between the 2 surgical stages to help improve the spine deformity correction while reducing the risk of neurologic complications.},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
BACKGROUND: Skin and soft tissue retraction secondary to burns of the trunk may induce severe and progressive thoracogenic spinal deformities in children. Its management is rarely described.nnCASE DESCRIPTION: Our study reports a case of severe thoracic scoliosis in a 13-year-old adolescent, secondary to soft tissue retraction due to trunk burn in early childhood. The Cobb angle of the scoliosis was 100 degrees. The 3-stage surgical strategy consisted of scar excision and skin graft in the first stage, halo gravity traction in the second stage, and posterior correction and fusion of the spine in the third and final stage. The postoperative course was satisfactory, and late follow-up at 1 year showed stable correction of the spine, with satisfactory coronal and sagittal balance and good healing of skin and soft tissues.nnDISCUSSION: While spinal deformities secondary to burns are rare, they require specific, sequential, and multidisciplinary medical and surgical management. Our surgical strategy was to treat skin and soft tissues retractions first and then address spinal deformity. We used halo-gravity traction between the 2 surgical stages to help improve the spine deformity correction while reducing the risk of neurologic complications.
Pietton, Raphael; Bouloussa, Houssam; Vergari, Claudio; Skalli, Wafa; Vialle, Raphael
Dans: J Pediatr Orthop, vol. 40, no. 1, p. 36–41, 2020, ISSN: 1539-2570.
@article{pmid31815860,
title = {Rib Cage Measurement Reproducibility Using Biplanar Stereoradiographic 3D Reconstructions in Adolescent Idiopathic Scoliosis},
author = {Raphael Pietton and Houssam Bouloussa and Claudio Vergari and Wafa Skalli and Raphael Vialle},
doi = {10.1097/BPO.0000000000001095},
issn = {1539-2570},
year = {2020},
date = {2020-01-01},
journal = {J Pediatr Orthop},
volume = {40},
number = {1},
pages = {36--41},
abstract = {BACKGROUND: A reproducibility study of preoperative rib cage three-dimensional (3D) measurements was conducted for patients with Adolescent Idiopathic Scoliosis (AIS). No prior reliability study has been performed for preoperative 3D reconstructions of the rib cage by using stereoradiography in patients with preoperative AIS. Our objective was to assess the reliability of rib cage 3D reconstructions using biplanar stereoradiography in patients with AIS before surgery.nnMETHODS: This series includes 21 patients with Lenke 1 or 2 scoliosis (74±20 degrees). All patients underwent low-dose standing biplanar radiographs. Two operators performed reconstructions twice each. Intraoperator repeatability, interoperator reproducibility, and intraclass coefficients (ICC) were calculated and compared between groups.nnRESULTS: The average rib cage volume was 4.71 L (SD±0.75 L). Two SD was 0.19 L with a coefficient of variation of 4.1%; ICC was 0.968. The thoracic index was 0.6 (SD±0.1). Two SD was 0.03 with a coefficient of variation of 4.7% and a ICC of 0.820. As for the Spinal Penetration Index (6.4%; SD±2.4), 2SD was 0.9% with a coefficient of variation of 14.3% and a ICC of 0.901. The 3D rib hump 2SD (average 27±8 degrees) was 1.4 degrees. The coefficient of variation and ICC were respectively 5.1% and 0.991.nnCONCLUSIONS: Three-dimensional reconstruction of the rib cage using biplanar stereoradiography is a reliable method to estimate preoperative thoracic parameters in patients with AIS.nnLEVEL OF EVIDENCE: Level IV-diagnostic study.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: A reproducibility study of preoperative rib cage three-dimensional (3D) measurements was conducted for patients with Adolescent Idiopathic Scoliosis (AIS). No prior reliability study has been performed for preoperative 3D reconstructions of the rib cage by using stereoradiography in patients with preoperative AIS. Our objective was to assess the reliability of rib cage 3D reconstructions using biplanar stereoradiography in patients with AIS before surgery.nnMETHODS: This series includes 21 patients with Lenke 1 or 2 scoliosis (74±20 degrees). All patients underwent low-dose standing biplanar radiographs. Two operators performed reconstructions twice each. Intraoperator repeatability, interoperator reproducibility, and intraclass coefficients (ICC) were calculated and compared between groups.nnRESULTS: The average rib cage volume was 4.71 L (SD±0.75 L). Two SD was 0.19 L with a coefficient of variation of 4.1%; ICC was 0.968. The thoracic index was 0.6 (SD±0.1). Two SD was 0.03 with a coefficient of variation of 4.7% and a ICC of 0.820. As for the Spinal Penetration Index (6.4%; SD±2.4), 2SD was 0.9% with a coefficient of variation of 14.3% and a ICC of 0.901. The 3D rib hump 2SD (average 27±8 degrees) was 1.4 degrees. The coefficient of variation and ICC were respectively 5.1% and 0.991.nnCONCLUSIONS: Three-dimensional reconstruction of the rib cage using biplanar stereoradiography is a reliable method to estimate preoperative thoracic parameters in patients with AIS.nnLEVEL OF EVIDENCE: Level IV-diagnostic study.
Multicentric evaluation of the adherence to Peristeen® transanal irrigation system in children
Lallemant-Dudek, P; Cretolle, C; Hameury, F; Lemelle, J L; Ranke, A; Louis-Borrione, C; Forin, V
Dans: Ann Phys Rehabil Med, vol. 63, no. 1, p. 28–32, 2020, ISSN: 1877-0665.
@article{pmid31051275,
title = {Multicentric evaluation of the adherence to Peristeen® transanal irrigation system in children},
author = {P Lallemant-Dudek and C Cretolle and F Hameury and J L Lemelle and A Ranke and C Louis-Borrione and V Forin},
doi = {10.1016/j.rehab.2019.04.003},
issn = {1877-0665},
year = {2020},
date = {2020-01-01},
journal = {Ann Phys Rehabil Med},
volume = {63},
number = {1},
pages = {28--32},
abstract = {BACKGROUND: Since 2009 in France, the Peristeen® transanal irrigation (TAI) device has represented an alternative treatment of faecal incontinence (FI).nnOBJECTIVE: The primary objective of this study was to assess the mid-term adherence to TAI in paediatric patients. The secondary objective was to identify factors determining TAI continuation.nnMETHODS: This observational study conducted in 5 French paediatric centres prospectively reviewed from March to May 2012 all children educated in TAI for at least 9months.nnRESULTS: We included 149 children (mean [SD] age 10.6 [4.1] years) educated in TAI. Children mainly had neurogenic disorders (52.3%) or congenital malformations (30.9%). The main symptoms motivating TAI initiation were recurring faecaloma (59.7%) and daily FI (65.1%). At last follow-up (mean 14 [7.4] months), 129 (86.6%) children continued the TAI procedure, independent of pathology or age. The main motivation was resolution of FI and/or constipation (77.3%). In total, 107 (82.9%) children fulfilled the initial therapeutic contract established with their healthcare professional before TAI initiation was met. Twenty children had stopped the TAI when they answered the questionnaire, at a mean duration of 16 (8.4) months. The reasons were mainly "lack of motivation" (45%), "poor tolerance" (35%), "difficulties" performing the procedure (35%) and "inefficacy" (30%). Factors related to continuation were performing at least one TAI procedure under a nurse's supervision during the initial training and prescribing TAI at a daily frequency (P=0.014 and P=0.04). Continuing constipation treatment after the training session was a factor in discontinuation (P=0.024).nnCONCLUSION: This study reports a very high mid-term adherence to TAI in a paediatric cohort, provided that the training is pragmatic, personalized and repeated.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Since 2009 in France, the Peristeen® transanal irrigation (TAI) device has represented an alternative treatment of faecal incontinence (FI).nnOBJECTIVE: The primary objective of this study was to assess the mid-term adherence to TAI in paediatric patients. The secondary objective was to identify factors determining TAI continuation.nnMETHODS: This observational study conducted in 5 French paediatric centres prospectively reviewed from March to May 2012 all children educated in TAI for at least 9months.nnRESULTS: We included 149 children (mean [SD] age 10.6 [4.1] years) educated in TAI. Children mainly had neurogenic disorders (52.3%) or congenital malformations (30.9%). The main symptoms motivating TAI initiation were recurring faecaloma (59.7%) and daily FI (65.1%). At last follow-up (mean 14 [7.4] months), 129 (86.6%) children continued the TAI procedure, independent of pathology or age. The main motivation was resolution of FI and/or constipation (77.3%). In total, 107 (82.9%) children fulfilled the initial therapeutic contract established with their healthcare professional before TAI initiation was met. Twenty children had stopped the TAI when they answered the questionnaire, at a mean duration of 16 (8.4) months. The reasons were mainly « lack of motivation » (45%), « poor tolerance » (35%), « difficulties » performing the procedure (35%) and « inefficacy » (30%). Factors related to continuation were performing at least one TAI procedure under a nurse’s supervision during the initial training and prescribing TAI at a daily frequency (P=0.014 and P=0.04). Continuing constipation treatment after the training session was a factor in discontinuation (P=0.024).nnCONCLUSION: This study reports a very high mid-term adherence to TAI in a paediatric cohort, provided that the training is pragmatic, personalized and repeated.
Maurice, Paul; Letourneau, Alexandra; Benachi, Alexandra; Jouannic, Jean-Marie
Dans: Prenat Diagn, vol. 39, no. 13, p. 1269–1272, 2019, ISSN: 1097-0223.
@article{pmid31671210,
title = {Feticide in second- and third-trimester termination of pregnancy for fetal anomalies: Results of a national survey},
author = {Paul Maurice and Alexandra Letourneau and Alexandra Benachi and Jean-Marie Jouannic},
doi = {10.1002/pd.5594},
issn = {1097-0223},
year = {2019},
date = {2019-12-01},
journal = {Prenat Diagn},
volume = {39},
number = {13},
pages = {1269--1272},
abstract = {OBJECTIVE: To conduct an audit of the practice of feticide in second- and third-trimester termination of pregnancy for fetal anomalies (TOPFA) in prenatal diagnosis (PD) centers in France.nnRESULTS: A questionnaire was sent out to the 49 French PD centers and completed by 39/49 centers; 5350 TOPFAs were performed. The gestational age after which feticide was performed was 20 weeks in two centers (5%), 22 weeks in 28 centers (72%), 23 weeks in four centers (10%), and 24 weeks in five centers (13%). Fifteen of 39 centers reported that feticide was not performed in all cases, because of a fetal abnormality associated with a high probability of rapid neonatal death (13 centers), pregnant woman's refusal (11 centers), and technical impossibility of performing feticide (one center). Feticide was done using xylocaine in 38 of the 39 centers and using KCl in the remaining center. All but one of the centers before feticide used fetal anesthesia. Feticide was done on the day of induction of labor in 35/39 centers (90%), after maternal epidural analgesia in 33 centers, or after maternal subcutaneous local anesthesia in two centers. Feticide was done the day before induction of labor in two centers.nnCONCLUSION: In France, most TOPFAs performed in second and third trimesters are associated with feticide, which is most often done after fetal anesthesia.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To conduct an audit of the practice of feticide in second- and third-trimester termination of pregnancy for fetal anomalies (TOPFA) in prenatal diagnosis (PD) centers in France.nnRESULTS: A questionnaire was sent out to the 49 French PD centers and completed by 39/49 centers; 5350 TOPFAs were performed. The gestational age after which feticide was performed was 20 weeks in two centers (5%), 22 weeks in 28 centers (72%), 23 weeks in four centers (10%), and 24 weeks in five centers (13%). Fifteen of 39 centers reported that feticide was not performed in all cases, because of a fetal abnormality associated with a high probability of rapid neonatal death (13 centers), pregnant woman’s refusal (11 centers), and technical impossibility of performing feticide (one center). Feticide was done using xylocaine in 38 of the 39 centers and using KCl in the remaining center. All but one of the centers before feticide used fetal anesthesia. Feticide was done on the day of induction of labor in 35/39 centers (90%), after maternal epidural analgesia in 33 centers, or after maternal subcutaneous local anesthesia in two centers. Feticide was done the day before induction of labor in two centers.nnCONCLUSION: In France, most TOPFAs performed in second and third trimesters are associated with feticide, which is most often done after fetal anesthesia.
Bouloussa, H; Pietton, R; Vergari, C; Haen, T X; Skalli, W; Vialle, R
Dans: Eur Spine J, vol. 28, no. 9, p. 1962–1969, 2019, ISSN: 1432-0932.
@article{pmid30895379,
title = {Biplanar stereoradiography predicts pulmonary function tests in adolescent idiopathic scoliosis: a cross-sectional study},
author = {H Bouloussa and R Pietton and C Vergari and T X Haen and W Skalli and R Vialle},
doi = {10.1007/s00586-019-05940-3},
issn = {1432-0932},
year = {2019},
date = {2019-09-01},
journal = {Eur Spine J},
volume = {28},
number = {9},
pages = {1962--1969},
abstract = {PURPOSE: Various spinal and rib cage parameters measured from complex examinations were found to be correlated with preoperative pulmonary function tests (PFT). The aim was to investigate the relationship between preoperative rib cage parameters and PFT using biplanar stereoradiography in patients with severe adolescent idiopathic scoliosis.nnMETHODS: Fifty-four patients, 45 girls and nine boys, aged 13.8 ± 1.2 years, with Lenke 1 or 2 thoracic scoliosis (> 50°) requiring surgical correction were prospectively included. All patients underwent preoperative PFT and low-dose biplanar X-rays. The following data were collected: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, residual volume, slow vital capacity (SVC), total lung capacity (TLC), rib cage volume (RCV), maximum rib hump, maximum width, mean thoracic index, spinal penetration index, apical vertebral rotation, main curve Cobb angle (MCCA), T4-T12 kyphosis. The primary outcome was the relationship between rib cage parameters and PFT. The secondary outcome was the relationship between rib cage parameters and spine parameters. Data were analyzed using Spearman's rank test. A multivariable regression analysis was performed to compare PFTs and structural parameters. Significance was set at α = 0.05.nnRESULTS: The mean MCCA was 68.7° ± 16.7°. RCV was highly correlated with all pulmonary capacities: TLC (r = 0.76, p < 0.0001), SVC (r = 0.78, p < 0.0001) and FVC (r = 0.77, p < 0.0001). RCV had a low correlation with FEV1/FVC (r = - 0.34, p = 0.014). SPI was not correlated with any pulmonary parameters.nnCONCLUSION: Rib cage volume measured by biplanar stereoradiography may represent a prediction tool for PFTs.nnLEVEL OF EVIDENCE: Non-randomized cross-sectional study among consecutive patients, Level 2. These slides can be retrieved under Electronic Supplementary Material.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: Various spinal and rib cage parameters measured from complex examinations were found to be correlated with preoperative pulmonary function tests (PFT). The aim was to investigate the relationship between preoperative rib cage parameters and PFT using biplanar stereoradiography in patients with severe adolescent idiopathic scoliosis.nnMETHODS: Fifty-four patients, 45 girls and nine boys, aged 13.8 ± 1.2 years, with Lenke 1 or 2 thoracic scoliosis (> 50°) requiring surgical correction were prospectively included. All patients underwent preoperative PFT and low-dose biplanar X-rays. The following data were collected: forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, residual volume, slow vital capacity (SVC), total lung capacity (TLC), rib cage volume (RCV), maximum rib hump, maximum width, mean thoracic index, spinal penetration index, apical vertebral rotation, main curve Cobb angle (MCCA), T4-T12 kyphosis. The primary outcome was the relationship between rib cage parameters and PFT. The secondary outcome was the relationship between rib cage parameters and spine parameters. Data were analyzed using Spearman’s rank test. A multivariable regression analysis was performed to compare PFTs and structural parameters. Significance was set at α = 0.05.nnRESULTS: The mean MCCA was 68.7° ± 16.7°. RCV was highly correlated with all pulmonary capacities: TLC (r = 0.76, p < 0.0001), SVC (r = 0.78, p < 0.0001) and FVC (r = 0.77, p < 0.0001). RCV had a low correlation with FEV1/FVC (r = - 0.34, p = 0.014). SPI was not correlated with any pulmonary parameters.nnCONCLUSION: Rib cage volume measured by biplanar stereoradiography may represent a prediction tool for PFTs.nnLEVEL OF EVIDENCE: Non-randomized cross-sectional study among consecutive patients, Level 2. These slides can be retrieved under Electronic Supplementary Material.
Pedersen, Peter H; Vergari, Claudio; Tran, Alexia; Xavier, Fred; Jaeger, Antoine; Laboudie, Pierre; Housset, Victor; Eiskjær, Søren P; Vialle, Raphäel
Dans: Clin Spine Surg, vol. 32, no. 7, p. E340–E345, 2019, ISSN: 2380-0194.
@article{pmid31162186,
title = {A Nano-Dose Protocol For Cobb Angle Assessment in Children With Scoliosis: Results of a Phantom-based and Clinically Validated Study},
author = {Peter H Pedersen and Claudio Vergari and Alexia Tran and Fred Xavier and Antoine Jaeger and Pierre Laboudie and Victor Housset and Søren P Eiskjær and Raphäel Vialle},
doi = {10.1097/BSD.0000000000000834},
issn = {2380-0194},
year = {2019},
date = {2019-08-01},
journal = {Clin Spine Surg},
volume = {32},
number = {7},
pages = {E340--E345},
abstract = {STUDY DESIGN: This was a prospective validation study with technical notes.nnOBJECTIVE: This study aimed to validate a new ultra-low-dose full-spine protocol for reproducible Cobb angle measurements-the "nano-dose" protocol.nnSUMMARY OF BACKGROUND DATA: Scoliosis is a 3-dimensional (3D) deformity of the spine characterized by 3D clinical parameters. Nevertheless, 2D Cobb angle remains an essential and widely used radiologic measure in clinical practice. Repeated imaging is required for the assessment and follow-up of scoliosis patients. The resultant high dose of absorbed radiation increases the potential risk of developing radiation-induced cancer in such patients. Micro-dose radiographic imaging is already available in clinical practice, but the radiation dose delivered to the patient could be further reduced.nnMETHODS: An anthropomorphic child phantom was used to establish an ultra-low-dose protocol in the EOS Imaging System still allowing Cobb angle measurements, defined as nano-dose. A group of 23 consecutive children presenting for scoliosis assessment, 12 years of age or younger, were assessed with standard-dose or micro-dose and additional nano-dose full-spine imaging modalities. Intraobserver and interobserver reliability of determining the reliability of 2D Cobb angle measurements was performed. The dosimetry was performed in the anthropomorphic phantom to confirm theoretical radiation dose reduction.nnRESULTS: A nano-dose protocol was established for reliable Cobb angle measurements. Dose area product with this new nano-dose protocol was reduced to 5 mGy×cm, corresponding to one sixth of the micro-dose protocol (30 mGy×cm) and <1/40th of the standard-dose protocol (222 mGy×cm). Theoretical dose reduction, for posteroanterolateral positioning was confirmed using phantom dosimetry. Our study showed good reliability and repeatability between the 2 groups. Cobb variability was <5 degrees from the mean using 95% confidence intervals.nnCONCLUSIONS: We propose a new clinically validated nano-dose protocol for routine follow-up of scoliosis patients before surgery, keeping the radiation dose at a bare minimum, while allowing for reproducible Cobb angle measurements.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
STUDY DESIGN: This was a prospective validation study with technical notes.nnOBJECTIVE: This study aimed to validate a new ultra-low-dose full-spine protocol for reproducible Cobb angle measurements-the « nano-dose » protocol.nnSUMMARY OF BACKGROUND DATA: Scoliosis is a 3-dimensional (3D) deformity of the spine characterized by 3D clinical parameters. Nevertheless, 2D Cobb angle remains an essential and widely used radiologic measure in clinical practice. Repeated imaging is required for the assessment and follow-up of scoliosis patients. The resultant high dose of absorbed radiation increases the potential risk of developing radiation-induced cancer in such patients. Micro-dose radiographic imaging is already available in clinical practice, but the radiation dose delivered to the patient could be further reduced.nnMETHODS: An anthropomorphic child phantom was used to establish an ultra-low-dose protocol in the EOS Imaging System still allowing Cobb angle measurements, defined as nano-dose. A group of 23 consecutive children presenting for scoliosis assessment, 12 years of age or younger, were assessed with standard-dose or micro-dose and additional nano-dose full-spine imaging modalities. Intraobserver and interobserver reliability of determining the reliability of 2D Cobb angle measurements was performed. The dosimetry was performed in the anthropomorphic phantom to confirm theoretical radiation dose reduction.nnRESULTS: A nano-dose protocol was established for reliable Cobb angle measurements. Dose area product with this new nano-dose protocol was reduced to 5 mGy×cm, corresponding to one sixth of the micro-dose protocol (30 mGy×cm) and <1/40th of the standard-dose protocol (222 mGy×cm). Theoretical dose reduction, for posteroanterolateral positioning was confirmed using phantom dosimetry. Our study showed good reliability and repeatability between the 2 groups. Cobb variability was <5 degrees from the mean using 95% confidence intervals.nnCONCLUSIONS: We propose a new clinically validated nano-dose protocol for routine follow-up of scoliosis patients before surgery, keeping the radiation dose at a bare minimum, while allowing for reproducible Cobb angle measurements.
Dhombres, Ferdinand; Maurice, Paul; Guilbaud, Lucie; Franchinard, Loriane; Dias, Barbara; Charlet, Jean; Blondiaux, Eléonore; Khoshnood, Babak; Jurkovic, Davor; Jauniaux, Eric; Jouannic, Jean-Marie
Dans: J Med Internet Res, vol. 21, no. 7, p. e14286, 2019, ISSN: 1438-8871.
@article{pmid31271152,
title = {A Novel Intelligent Scan Assistant System for Early Pregnancy Diagnosis by Ultrasound: Clinical Decision Support System Evaluation Study},
author = {Ferdinand Dhombres and Paul Maurice and Lucie Guilbaud and Loriane Franchinard and Barbara Dias and Jean Charlet and Eléonore Blondiaux and Babak Khoshnood and Davor Jurkovic and Eric Jauniaux and Jean-Marie Jouannic},
doi = {10.2196/14286},
issn = {1438-8871},
year = {2019},
date = {2019-07-01},
journal = {J Med Internet Res},
volume = {21},
number = {7},
pages = {e14286},
abstract = {BACKGROUND: Early pregnancy ultrasound scans are usually performed by nonexpert examiners in obstetrics/gynecology (OB/GYN) emergency departments. Establishing the precise diagnosis of pregnancy location is key for appropriate management of early pregnancies, and experts are usually able to locate a pregnancy in the first scan. A decision-support system based on a semantic, expert-validated knowledge base may improve the diagnostic performance of nonexpert examiners for early pregnancy transvaginal ultrasound.nnOBJECTIVE: This study aims to evaluate a novel Intelligent Scan Assistant System for early pregnancy ultrasound to diagnose the pregnancy location and determine the image quality.nnMETHODS: Two trainees performed virtual transvaginal ultrasound examinations of early pregnancy cases with and without the system. The ultrasound images and reports were blindly reviewed by two experts using scoring methods. A diagnosis of pregnancy location and ultrasound image quality were compared between scans performed with and without the system.nnRESULTS: Each trainee performed a virtual vaginal examination for all 32 cases with and without use of the system. The analysis of the 128 resulting scans showed higher quality of the images (quality score: +23%; P<.001), less images per scan (4.6 vs 6.3 [without the CDSS]; P<.001), and higher confidence in reporting conclusions (trust score: +20%; P<.001) with use of the system. Further, use of the system cost an additional 8 minutes per scan. We observed a correct diagnosis of pregnancy location in 39 (61%) and 52 (81%) of 64 scans in the nonassisted mode and assisted mode, respectively. Additionally, an exact diagnosis (with precise ectopic location) was made in 30 (47%) and 49 (73%) of the 64 scans without and with use of the system, respectively. These differences in diagnostic performance (+20% for correct location diagnosis and +30% for exact diagnosis) were both statistically significant (P=.002 and P<.001, respectively).nnCONCLUSIONS: The Intelligent Scan Assistant System is based on an expert-validated knowledge base and demonstrates significant improvement in early pregnancy scanning, both in diagnostic performance (pregnancy location and precise diagnosis) and scan quality (selection of images, confidence, and image quality).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND: Early pregnancy ultrasound scans are usually performed by nonexpert examiners in obstetrics/gynecology (OB/GYN) emergency departments. Establishing the precise diagnosis of pregnancy location is key for appropriate management of early pregnancies, and experts are usually able to locate a pregnancy in the first scan. A decision-support system based on a semantic, expert-validated knowledge base may improve the diagnostic performance of nonexpert examiners for early pregnancy transvaginal ultrasound.nnOBJECTIVE: This study aims to evaluate a novel Intelligent Scan Assistant System for early pregnancy ultrasound to diagnose the pregnancy location and determine the image quality.nnMETHODS: Two trainees performed virtual transvaginal ultrasound examinations of early pregnancy cases with and without the system. The ultrasound images and reports were blindly reviewed by two experts using scoring methods. A diagnosis of pregnancy location and ultrasound image quality were compared between scans performed with and without the system.nnRESULTS: Each trainee performed a virtual vaginal examination for all 32 cases with and without use of the system. The analysis of the 128 resulting scans showed higher quality of the images (quality score: +23%; P<.001), less images per scan (4.6 vs 6.3 [without the CDSS]; P<.001), and higher confidence in reporting conclusions (trust score: +20%; P<.001) with use of the system. Further, use of the system cost an additional 8 minutes per scan. We observed a correct diagnosis of pregnancy location in 39 (61%) and 52 (81%) of 64 scans in the nonassisted mode and assisted mode, respectively. Additionally, an exact diagnosis (with precise ectopic location) was made in 30 (47%) and 49 (73%) of the 64 scans without and with use of the system, respectively. These differences in diagnostic performance (+20% for correct location diagnosis and +30% for exact diagnosis) were both statistically significant (P=.002 and P<.001, respectively).nnCONCLUSIONS: The Intelligent Scan Assistant System is based on an expert-validated knowledge base and demonstrates significant improvement in early pregnancy scanning, both in diagnostic performance (pregnancy location and precise diagnosis) and scan quality (selection of images, confidence, and image quality).
Ferrier, Clément; Dhombres, Ferdinand; Khoshnood, Babak; Randrianaivo, Hanitra; Perthus, Isabelle; Guilbaut, Lucie; Durand-Zaleski, Isabelle; Jouannic, Jean-Marie
Dans: BMJ Open, vol. 9, no. 2, p. e025482, 2019, ISSN: 2044-6055.
@article{pmid30772861,
title = {Trends in resource use and effectiveness of ultrasound detection of fetal structural anomalies in France: a multiple registry-based study},
author = {Clément Ferrier and Ferdinand Dhombres and Babak Khoshnood and Hanitra Randrianaivo and Isabelle Perthus and Lucie Guilbaut and Isabelle Durand-Zaleski and Jean-Marie Jouannic},
doi = {10.1136/bmjopen-2018-025482},
issn = {2044-6055},
year = {2019},
date = {2019-02-01},
journal = {BMJ Open},
volume = {9},
number = {2},
pages = {e025482},
abstract = {OBJECTIVE: To analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France.nnDESIGN: A multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed).nnSETTING: Three registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France.nnPARTICIPANTS: There were two samples of pregnant women. Effectiveness was assessed using data from three French birth defect registries. Resource use for ultrasound screening was based on the French national healthcare database.nnMAIN OUTCOME MEASURES: The main outcome measures were prenatal diagnosis (effectiveness) and the average number of ultrasounds (resource use). Statistical analyses included linear and logistic regression models to assess trends in resource use and effectiveness of prenatal testing, respectively.nnRESULTS: The average number of ultrasound examinations per pregnancy significantly increased over the study period, from 2.47 in 2006 to 2.98 in 2014 (p=0.005). However, there was no significant increase in the odds of prenatal diagnosis. The probability of prenatal diagnosis was substantially higher for cases associated with a chromosomal anomaly (91.2%) than those without (51.8%). However, there was no evidence of an increase in prenatal detection of either over time.nnCONCLUSIONS: The average number of ultrasound examinations per pregnancy increased over time, whereas the probability of prenatal diagnosis of congenital anomalies did not. Hence, there is a need to implement policies such as high-quality training programmes which can improve the efficiency of ultrasound examinations for prenatal detection of congenital anomalies.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
OBJECTIVE: To analyse trends in the number of ultrasound examinations in relation to the effectiveness of prenatal detection of birth defects using population-based data in France.nnDESIGN: A multiple registry-based study of time trends in resource use (number of ultrasounds) and effectiveness (proportion of cases prenatally diagnosed).nnSETTING: Three registries of congenital anomalies and claims data on ultrasounds for all pregnant women in France.nnPARTICIPANTS: There were two samples of pregnant women. Effectiveness was assessed using data from three French birth defect registries. Resource use for ultrasound screening was based on the French national healthcare database.nnMAIN OUTCOME MEASURES: The main outcome measures were prenatal diagnosis (effectiveness) and the average number of ultrasounds (resource use). Statistical analyses included linear and logistic regression models to assess trends in resource use and effectiveness of prenatal testing, respectively.nnRESULTS: The average number of ultrasound examinations per pregnancy significantly increased over the study period, from 2.47 in 2006 to 2.98 in 2014 (p=0.005). However, there was no significant increase in the odds of prenatal diagnosis. The probability of prenatal diagnosis was substantially higher for cases associated with a chromosomal anomaly (91.2%) than those without (51.8%). However, there was no evidence of an increase in prenatal detection of either over time.nnCONCLUSIONS: The average number of ultrasound examinations per pregnancy increased over time, whereas the probability of prenatal diagnosis of congenital anomalies did not. Hence, there is a need to implement policies such as high-quality training programmes which can improve the efficiency of ultrasound examinations for prenatal detection of congenital anomalies.