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Videophones in the diagnosis of acute upper airway obstruction in children
- Graham A M Wilson, Thomas Engelhardt, Bruno Marciniak (29 October 2007)
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Multi Media Assessments
- Rhys H Thomas (30 October 2007)
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Graham A M Wilson, Consultant Paediatric Anaesthetist Royal Aberdeen Children's Hospital AB25 2ZN, Thomas Engelhardt, Bruno Marciniak
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Sir, we wish to respond to Ashworth's letter (1) regarding the value of mobile phone video footage for treatment of the sick child. In our institutions there have been two recent cases whereby video provided by parents was deemed very valuable in the diagnosis and treatment of upper airway obstruction. A previously healthy 2.5 year old boy was reported by his parents to have severe respiratory distress at night which completely resolved during the day. He was seen on several occasions at a remote outpatient clinic by a family doctor and ENT specialist. No diagnosis was made as the child appears to be well and in no distress. Finally, his parents presented a video recording from a mobile phone camera showing a boy asleep in severe respiratory distress http://s214.photobucket.com/albums/cc73/gmacwilson/. He subsequently underwent an examination under general anaesthesia including direct laryngoscopy and bronchoscopy. He required urgent adenotonsillectomy and made an uneventful recovery with complete resolution of his symptoms. The second patient is a 13 year old girl with cystic fibrosis presenting for anaesthesia assessment for a scheduled bronchoscopy. The child appeared well throughout the consultation without any signs of respiratory distress but the parents supplied a video recording from a mobile phone demonstrating her in respiratory distress in the morning or when anxious. She successfully underwent a diagnostic bronchoscopy and postoperative respiratory symptoms were consistent with the mobile phone recordings. There are only very few reports of the use of video mobile phones for diagnosis, and none reporting its use in children. (2,3,4). The presence of acute upper airway obstruction during sleep in an apparently healthy child could lead to potentially life threatening complications if sedation for simple investigations and procedures are employed. These cases highlight the usefulness of modern technology in the diagnosis of problems of uncertain severity in children and may represent a useful alternative to inpatient admissions.
References 1.Ashworth AJ.Mobile phone videos could help treat sick children. BMJ, Sep 2007; 335: 627 2. Parikh R, Wong R. Video phone diagnosis of ‘funny turns’. Age Ageing. 2007; 36: 233-4. 3.Armstrong D. The mobile phone as an imaging tool in SLE. Rheumatology 2004; 43: 1195. 4.Braun RP, Vecchietti JL, Thomas L, Prins C, French LE, Gewirtzman AJ, Saurat JH, Salomon D. Telemedical wound care using a new generation of mobile telephones: a feasibility study. Arch Dermatol. 2005;141: 254-8. Competing interests: None declared Editorial note
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Rhys H Thomas, Speciality Registrar (ST2) Neuro Rehab Rookwood Hospital, Llandaff, CF5 2YN
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Dear Sir, I won’t be the only person who has found mobile phone media messages assisting in diagnosing adults over the last few years. (1) Two cases spring to mind. The first was of a patient transferred to our unit who had repeated surgical interventions to help a wound that had dehisced. On first viewing, even with the help of the notes, it was not clear whether the area had deteriorated. So I asked his son, who helpfully said, “You should have seen it before, Doc” and then gave me the opportunity, showing me the multiple pictures he had taken of his poor father's wound. His son's inquisitive documentation probably saved him unnecessary antibiotics. The second case occurred in an outpatient neurology clinic. Whilst seeing new cases of 'collapse query fit' it was my role to agonisingly tease out the details of the event. This patient made me stew for a while before offering me the video footage taken, “If you're that interested, would you like to have a look?” I was, so I did. A recent review of 'epilepsy' and 'seizure' clips uploaded to video sharing site You Tube noted that pseudoseizures outnumbered genuine fits 10:1. (2) This suggests that the videos taken were of good enough quality to be assessed as fits or not. Assessment of sick children may be possible this way too. Rhys Thomas References 1. Ashworth, A Mobile phone videos could help treat sick children BMJ 2007;335:627 2. M. D. Cossburn, P. E. M. Smith. Seizures on “You Tube”: How is epilepsy represented in the new media? JNNP 2007;78:1014-1038 Competing interests: None declared |
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