- Email: [email protected]
315
Research Forum Abstracts child restraint law very well. Compliance was high for those with very young children but decreased as children reached the age where booster seats were required.
Apnea Characteristics with Respect to Length of Illness 35
Walsh P, Kimmel L, Feola M, Pusavat J, Mordechai E, Adelson ME/Kern Medical Center, Bakersfield, CA; Medical Diagnostic Laboratories, Hamilton, NJ
Background: Mandatory hospital admission for infants less than 6 and 2 months of age with pertussis and respiratory syncytial virus (RSV) respectively has been recommended. Although pertussis infection is generally characterized by paroxysmal cough it can also cause an illness clinically indistinguishable from RSV bronchiolitis. Study Objective: To determine the prevalence of Bordetella ssp. infections in patients being screened for RSV infection. Methods: Discarded samples submitted to a clinical hospital laboratory for RSV testing were included. Following RSV antigen testing, all samples were refrigerated at 4°C prior to being aliquoted into DNase-free transport containers and frozen to ⫺70°C. Upon receipt at the diagnostic testing laboratory, the nasopharyngeal aspirate specimens were thawed and DNA was extracted using an automated Corbett Robotics X-tractor Gene system. Extracted DNA from these specimens were subsequently tested by Bordetella pertussis and Bordetella parapertussis species-specific real-time PCR assays designed and optimized to target conserved regions within a complement gene and the CarB gene, respectively. A Bordetella spp. genus-specific real-time PCR assay was also designed to detect the Bhur gene of B. pertussis, B. parapertussis, and B. bronchiseptica. Exact confidence intervals were calculated using STATA 9.1. Results: Discarded samples from 489 patients from family practice, pediatric and emergency department patients were collected over a five-month period. Bordetella pertussis testing was performed in 488 of which 3 (0.61%) (95% CI 0.13% to 1.8%) were positive. B. parapertussis testing was performed in 313 of which 4 (1.2%) (95% CI 0.35% to 3.2%) were positive. In one additional case from 210 that were tested, the Bordetella spp. genus-specific primers detected an additional positive specimen while both species-specific assays were negative; this specimen is being further investigated for B. bronchiseptica. Conclusion: B. pertussis occurred in less than 2% of infants and toddlers screened for RSV across multiple settings. Limitations: Patient selection was uncontrolled. Data was collected from a single county healthcare system over a single season.
315
Apnea Complicating RSV Infection in Infancy
Arms JL, Ortega HW, Finkelstein M, Reid SR/Childrens Hospitals of Minnesota, St Paul, MN; Childrens Hospitals of Minnesota, Minneapolis, MN
Study Objectives: To estimate the percentage of infants who experience clinically significant apnea during RSV infection; to determine the age range of affected patients, the time frame during illness in which infants are most at risk for apnea; and to identify clinical variables associated with apnea. Methods: Retrospective chart review of all emergency department patients ⬍ 1 year of age who tested positive for RSV during 2004. Additional cases of RSVassociated apnea were identified from 2000-2003, 2005 by ICD-9 codes. Data abstracted included age, duration of illness and other selected clinical variables. Results: During 2004, 184 patients met inclusion criteria. Of these, 13 (7%) experienced clinically significant apnea. 29 additional patients with RSV infection and apnea were identified and confirmed from 2000-2003 and 2005. Analysis of all patients demonstrated that apnea occured between the 1st and 12th days of illness (median ⫽ 4) and in infants between 11 and 330 days of age (median ⫽ 39). Independent variables associated with apnea were: age less than 3 months, heart rate less than 160, history of cough and absence of wheezing on exam. Conclusion: In our sample, clinically significant apnea affected a substantial proportion of patients. Most infants who experienced apnea did so before the age of 3 months. Although episodes of apnea occurred across a range of days in the course of illness, most patients had less than two days of apnea (see Figure).
Volume , . : October
total # of days with apnea
25 Total = 42
314
Length of illness at 1st apnea
30
Prevalence of Bordetella Spp. Infections in Samples Screened for Respiratory Syncytial Virus
20 15 10 5 0 <1
1
2
3
4
5
6
7
8
9
10
11
12
Days
316
Infrared Thermography of Facial Skin Temperatures Compared with Oral Thermometry: A Device for Syndromic Surveillance by Remote Detection
Varney SM, Holder AD, Bebarta VS, Schmelz JO/Wilford Hall Medical Center, Lackland AFB, TX
Study Objectives: Syndromic surveillance with fever detection is a useful tool for detecting outbreaks such as severe acute respiratory syndrome (SARS), avian flu, influenza, and detecting weaponized bioterrorism agents. With the high prevalence of world travel and threat of terrorism, rapid screening for pyrexia in highly populated places such as airports may be an important tool to protect the public health. Fever detection is usually done with oral, aural or rectal thermometers. Infrared (IR) cameras are noninvasive, quick, detect temperatures remotely, and may offer an alternative. The purpose of this study was to determine the correlation between oral thermometry and IR camera measurements of body surface temperature as a marker for fever. Methods: This IRB-approved prospective unsponsored study measured temperatures with a disposable oral thermometer (NexTemp) and 2 commercial IR cameras–CTI (Commercial Thermal Imaging, Incorporated [Inc.]) and Mikron (Mikron Infrared, Inc.). The cameras were calibrated with a portable M310 Blackbody calibration source (Mikron Infrared, Inc.). Volunteers sat in front of the IR cameras. Each camera recorded one facial view, a forehead view (head down), and one with the head turned 45° (off angle). Means, standard deviations and confidence limits were calculated with SAS (SAS Inc., Cary, NC). Mean differences taken by thermometer and 3 views of IR camera were analyzed using repeated measures of analysis of variance and analysis of covariance. Results: 401 volunteers were enrolled. The mean oral temperature was 97.8°F (range 91-103.6) (SD ⫹/⫺1.24). Over 2800 thermal images were captured. Twelve subjects (3%) had an oral temperature above 100.4°F. The maximum facial skin temperature was used for each image. Micron IR camera mean temperatures were 93.1°F (SD ⫹/⫺1.59) for face view, 92.9°F (SD ⫹/⫺1.58) head down, and 93.3°F (SD ⫹/⫺1.53) off-angle. The difference in means between the oral temperature and Micron IR camera views were 4.72°F for face (SD ⫹/⫺1.44), 4.92°F (SD ⫹/⫺1.43) head down, and 4.51°F (⫹/⫺SD 1.40) off-angle. Correlation between mean oral and Micron IR temperatures was moderate (0.506 - 0.510). CTI IR camera mean temperatures were 94.5°F (SD ⫹/⫺1.05) for face, 94.4°F (SD ⫹/⫺1.01) head down, and 94.7°F (SD ⫹/⫺.06) off-angle. Differences in means between oral thermometer and CTI IR camera views were 3.32°F (SD ⫹/⫺1.12) for face, 3.43°F (SD ⫹/7minus;1.10) head down, and 3.16°F (SD ⫹/⫺1.13) off-angle. Correlation between mean oral and CTI IR temperatures was moderate (0.530 - 0.540). Conclusion: Both IR cameras recorded skin temperatures lower than oral temperatures. Mikron differed by 4.5°F (⬎ 3 SD) and CTI differed by 3°F (⬎ 2 SD). CTI measurements were more than 1°F closer to the oral temperature than Micron results, but still had a large discrepancy. Based on our preliminary data, the Micron and CTI IR camera readings of facial temperatures are not reliable measurements of oral temperatures.
Annals of Emergency Medicine S95
Apnea Characteristics with Respect to Length of Illness 35
Walsh P, Kimmel L, Feola M, Pusavat J, Mordechai E, Adelson ME/Kern Medical Center, Bakersfield, CA; Medical Diagnostic Laboratories, Hamilton, NJ
Background: Mandatory hospital admission for infants less than 6 and 2 months of age with pertussis and respiratory syncytial virus (RSV) respectively has been recommended. Although pertussis infection is generally characterized by paroxysmal cough it can also cause an illness clinically indistinguishable from RSV bronchiolitis. Study Objective: To determine the prevalence of Bordetella ssp. infections in patients being screened for RSV infection. Methods: Discarded samples submitted to a clinical hospital laboratory for RSV testing were included. Following RSV antigen testing, all samples were refrigerated at 4°C prior to being aliquoted into DNase-free transport containers and frozen to ⫺70°C. Upon receipt at the diagnostic testing laboratory, the nasopharyngeal aspirate specimens were thawed and DNA was extracted using an automated Corbett Robotics X-tractor Gene system. Extracted DNA from these specimens were subsequently tested by Bordetella pertussis and Bordetella parapertussis species-specific real-time PCR assays designed and optimized to target conserved regions within a complement gene and the CarB gene, respectively. A Bordetella spp. genus-specific real-time PCR assay was also designed to detect the Bhur gene of B. pertussis, B. parapertussis, and B. bronchiseptica. Exact confidence intervals were calculated using STATA 9.1. Results: Discarded samples from 489 patients from family practice, pediatric and emergency department patients were collected over a five-month period. Bordetella pertussis testing was performed in 488 of which 3 (0.61%) (95% CI 0.13% to 1.8%) were positive. B. parapertussis testing was performed in 313 of which 4 (1.2%) (95% CI 0.35% to 3.2%) were positive. In one additional case from 210 that were tested, the Bordetella spp. genus-specific primers detected an additional positive specimen while both species-specific assays were negative; this specimen is being further investigated for B. bronchiseptica. Conclusion: B. pertussis occurred in less than 2% of infants and toddlers screened for RSV across multiple settings. Limitations: Patient selection was uncontrolled. Data was collected from a single county healthcare system over a single season.
315
Apnea Complicating RSV Infection in Infancy
Arms JL, Ortega HW, Finkelstein M, Reid SR/Childrens Hospitals of Minnesota, St Paul, MN; Childrens Hospitals of Minnesota, Minneapolis, MN
Study Objectives: To estimate the percentage of infants who experience clinically significant apnea during RSV infection; to determine the age range of affected patients, the time frame during illness in which infants are most at risk for apnea; and to identify clinical variables associated with apnea. Methods: Retrospective chart review of all emergency department patients ⬍ 1 year of age who tested positive for RSV during 2004. Additional cases of RSVassociated apnea were identified from 2000-2003, 2005 by ICD-9 codes. Data abstracted included age, duration of illness and other selected clinical variables. Results: During 2004, 184 patients met inclusion criteria. Of these, 13 (7%) experienced clinically significant apnea. 29 additional patients with RSV infection and apnea were identified and confirmed from 2000-2003 and 2005. Analysis of all patients demonstrated that apnea occured between the 1st and 12th days of illness (median ⫽ 4) and in infants between 11 and 330 days of age (median ⫽ 39). Independent variables associated with apnea were: age less than 3 months, heart rate less than 160, history of cough and absence of wheezing on exam. Conclusion: In our sample, clinically significant apnea affected a substantial proportion of patients. Most infants who experienced apnea did so before the age of 3 months. Although episodes of apnea occurred across a range of days in the course of illness, most patients had less than two days of apnea (see Figure).
Volume , . : October
total # of days with apnea
25 Total = 42
314
Length of illness at 1st apnea
30
Prevalence of Bordetella Spp. Infections in Samples Screened for Respiratory Syncytial Virus
20 15 10 5 0 <1
1
2
3
4
5
6
7
8
9
10
11
12
Days
316
Infrared Thermography of Facial Skin Temperatures Compared with Oral Thermometry: A Device for Syndromic Surveillance by Remote Detection
Varney SM, Holder AD, Bebarta VS, Schmelz JO/Wilford Hall Medical Center, Lackland AFB, TX
Study Objectives: Syndromic surveillance with fever detection is a useful tool for detecting outbreaks such as severe acute respiratory syndrome (SARS), avian flu, influenza, and detecting weaponized bioterrorism agents. With the high prevalence of world travel and threat of terrorism, rapid screening for pyrexia in highly populated places such as airports may be an important tool to protect the public health. Fever detection is usually done with oral, aural or rectal thermometers. Infrared (IR) cameras are noninvasive, quick, detect temperatures remotely, and may offer an alternative. The purpose of this study was to determine the correlation between oral thermometry and IR camera measurements of body surface temperature as a marker for fever. Methods: This IRB-approved prospective unsponsored study measured temperatures with a disposable oral thermometer (NexTemp) and 2 commercial IR cameras–CTI (Commercial Thermal Imaging, Incorporated [Inc.]) and Mikron (Mikron Infrared, Inc.). The cameras were calibrated with a portable M310 Blackbody calibration source (Mikron Infrared, Inc.). Volunteers sat in front of the IR cameras. Each camera recorded one facial view, a forehead view (head down), and one with the head turned 45° (off angle). Means, standard deviations and confidence limits were calculated with SAS (SAS Inc., Cary, NC). Mean differences taken by thermometer and 3 views of IR camera were analyzed using repeated measures of analysis of variance and analysis of covariance. Results: 401 volunteers were enrolled. The mean oral temperature was 97.8°F (range 91-103.6) (SD ⫹/⫺1.24). Over 2800 thermal images were captured. Twelve subjects (3%) had an oral temperature above 100.4°F. The maximum facial skin temperature was used for each image. Micron IR camera mean temperatures were 93.1°F (SD ⫹/⫺1.59) for face view, 92.9°F (SD ⫹/⫺1.58) head down, and 93.3°F (SD ⫹/⫺1.53) off-angle. The difference in means between the oral temperature and Micron IR camera views were 4.72°F for face (SD ⫹/⫺1.44), 4.92°F (SD ⫹/⫺1.43) head down, and 4.51°F (⫹/⫺SD 1.40) off-angle. Correlation between mean oral and Micron IR temperatures was moderate (0.506 - 0.510). CTI IR camera mean temperatures were 94.5°F (SD ⫹/⫺1.05) for face, 94.4°F (SD ⫹/⫺1.01) head down, and 94.7°F (SD ⫹/⫺.06) off-angle. Differences in means between oral thermometer and CTI IR camera views were 3.32°F (SD ⫹/⫺1.12) for face, 3.43°F (SD ⫹/7minus;1.10) head down, and 3.16°F (SD ⫹/⫺1.13) off-angle. Correlation between mean oral and CTI IR temperatures was moderate (0.530 - 0.540). Conclusion: Both IR cameras recorded skin temperatures lower than oral temperatures. Mikron differed by 4.5°F (⬎ 3 SD) and CTI differed by 3°F (⬎ 2 SD). CTI measurements were more than 1°F closer to the oral temperature than Micron results, but still had a large discrepancy. Based on our preliminary data, the Micron and CTI IR camera readings of facial temperatures are not reliable measurements of oral temperatures.
Annals of Emergency Medicine S95