Name: handheld metal detector screening for metallic foreign body ingestion in children
Uploaded: 2018-09-11T15:00:00
Description: Watch this Scientific Journal Video about Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children at JoVE.com

作者感谢李潘文凯针, 头 & 资深顾问, 儿童急诊, KK 妇女和儿童医院, 100 武吉天然路, 新加坡为行政支持与视频文章制作。在 "儿科紧急情况下金属异物摄取手持金属探测器" 许可下转载的文章;2018年8月:85 (8): 618–624;Hazwani Binte 哈姆扎王子、守夜詹姆斯、苏拉吉马尼卡姆、Sashikumar Ganapathy: 版权所有印度儿科杂志。

该议定书遵循机构人类研究伦理委员会的准则。中央机构审查委员会为这项研究提供了道德上的批准。
1. 参加者筛选
<ol><li>招募向儿科急诊科的病人提供异物摄取病史。</li>
	<li>排除呼吸窘迫的病人, 并植入了类似于速度器的设备。</li>
</ol>2. 准备病人
<ol><li>给病人穿上医院礼服。</li>
	<li>删除所有可能包含金属物体, 如衣服, 眼睛眼镜, 耳环, 挂件, 和饰物?...

<ol>
	<li>Lee, J., Ahmad, S., Gale, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+coins+ingested+by+children+using+a+handheld+metal+detector:+a+systematic+review.">Detection of coins ingested by children using a handheld metal detector: a systematic review.</a> Emergency Medicine Journal. 22 (12), 839-844 (2005).</li><li>Hesham A-Kader, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Foreign+body+ingestion:+children+like+to+put+objects+in+their+mouth.">Foreign body ingestion: children like to put objects in their mouth.</a> World Journal of Pediatrics. 6 (4), 301-310 (2010).</li><li>Muensterer, O. J., Joppich, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Identification+and+topographic+localization+of+metallic+foreign+bodies+by+metal+detector.">Identification and topographic localization of metallic foreign bodies by metal detector.</a> Journal of Pediatric Surgery. 39 (8), 1245-1248 (2004).</li><li>Nation, J., Jiang, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+utility+of+a+handheld+metal+detector+in+detection+and+localization+of+pediatric+metallic+foreign+body+ingestion.">The utility of a handheld metal detector in detection and localization of pediatric metallic foreign body ingestion.</a> International Journal of Pediatric Otorhinolaryngology. 92, 1-6 (2017).</li><li>Arena, L., Baker, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+metal+detector+to+identify+ingested+metallic+foreign+bodies.">Use of a metal detector to identify ingested metallic foreign bodies.</a> American Journal of Roentgenology. 155 (4), 803-804 (1990).</li><li>Younger, R. M., Darrow, D. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Handheld+metal+detector+confirmation+of+radiopaque+foreign+bodies+in+the+esophagus.">Handheld metal detector confirmation of radiopaque foreign bodies in the esophagus.</a> Archives of Otolaryngology--Head &amp; Neck Surgery. 127 (11), 1371-1374 (2001).</li><li>Schalamon, J., Haxhija, E. Q., Ainoedhofer, H., G&#246;ssler, A., Schleef, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+a+hand-held+metal+detector+for+localisation+of+ingested+metallic+foreign+bodies+-+a+critical+investigation.">The use of a hand-held metal detector for localisation of ingested metallic foreign bodies - a critical investigation.</a> European Journal of Pediatrics. 163 (4-5), 257-259 (2004).</li><li>Kay, M., Wyllie, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+foreign+bodies+and+their+management.">Pediatric foreign bodies and their management.</a> Current Gastroenterology Reports. 7 (3), 212-218 (2005).</li><li>Rothmann, B. F., Boeckman, C. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Foreign+bodies+in+the+larynx+and+tracheobronchial+tree+in+children.+A+review+of+225+cases.">Foreign bodies in the larynx and tracheobronchial tree in children. A review of 225 cases.</a> The Annals of Otology, Rhinology, and Laryngology. 89 (5), 434-436 (1980).</li><li>Pugmire, B. S., Lim, R., Avery, L. 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W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Fluoroscopic+foley+catheter+removal+of+esophageal+foreign+bodies+in+children:+experience+with+415+episodes.">Fluoroscopic foley catheter removal of esophageal foreign bodies in children: experience with 415 episodes.</a> Pediatrics. 94 (5), 709-714 (1994).</li><li>Kerschner, J. E., Beste, D. J., Conley, S. F., Kenna, M. A., Lee, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mediastinitis+associated+with+foreign+body+erosion+of+the+esophagus+in+children.">Mediastinitis associated with foreign body erosion of the esophagus in children.</a> International Journal of Pediatric Otorhinolaryngology. 59 (2), 89-97 (2001).</li><li>Ahn, D., Heo, S. J., Park, J. H., Sohn, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracheoesophageal+fistula+with+tracheal+stenosis+resulting+from+retained+esophageal+foreign+body.">Tracheoesophageal fistula with tracheal stenosis resulting from retained esophageal foreign body.</a> Auris Nasus Larynx. 38 (6), 753-756 (2011).</li><li>Dahiya, M., Denton, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Esophagoaortic+perforation+by+foreign+body+(coin)+causing+sudden+death+in+a+3-year-old+child.">Esophagoaortic perforation by foreign body (coin) causing sudden death in a 3-year-old child.</a> The American Journal of Forensic Medicine and Pathology. 20 (2), 184-188 (1999).</li><li>O'Brien, G. C., Winter, D. C., Kirwan, W. O., Redmond, H. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ingested+foreign+bodies+in+the+paediatric+patient.">Ingested foreign bodies in the paediatric patient.</a> Irish Journal of Medical Science. 170 (2), 100-102 (2001).</li><li>Bassett, K. E., Schunk, J. E., Logan, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Localizing+ingested+coins+with+a+metal+detector.">Localizing ingested coins with a metal detector.</a> The American Journal of Emergency Medicine. 17 (4), 338-341 (1999).</li><li>Gooden, E. A., Forte, V., Papsin, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+commercially+available+metal+detector+for+the+localization+of+metallic+foreign+body+ingestion+in+children.">Use of a commercially available metal detector for the localization of metallic foreign body ingestion in children.</a> The Journal of Otolaryngology. 29 (4), 218-220 (2000).</li><li>Sacchetti, A., Carraccio, C., Lichenstein, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hand-held+metal+detector+identification+of+ingested+foreign+bodies.">Hand-held metal detector identification of ingested foreign bodies.</a> Pediatric Emergency Care. 10 (4), 204-207 (1994).</li><li>Hamzah, H. B., James, V., Manickam, S., Ganapathy, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Handheld+Metal+Detector+for+Metallic+Foreign+Body+Ingestion+in+Pediatric+Emergency.">Handheld Metal Detector for Metallic Foreign Body Ingestion in Pediatric Emergency.</a> Indian Journal of Pediatrics. 85 (8), 618-624 (2018).</li><li>Doraiswamy, N. V., Baig, H., Hallam, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Metal+detector+and+swallowed+metal+foreign+bodies+in+children.">Metal detector and swallowed metal foreign bodies in children.</a> Journal of Accident &amp; Emergency Medicine. 16 (2), 123-125 (1999).</li><li>Seikel, K., Primm, P. A., Elizondo, B. J., Remley, K. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Handheld+metal+detector+localization+of+ingested+metallic+foreign+bodies:+accurate+in+any+hands.">Handheld metal detector localization of ingested metallic foreign bodies: accurate in any hands.</a> Archives of Pediatrics &amp; Adolescent Medicine. 153 (8), 853-857 (1999).</li><li>Lemberg, P. S., Darrow, D. H., Holinger, L. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aerodigestive+tract+foreign+bodies+in+the+older+child+and+adolescent.">Aerodigestive tract foreign bodies in the older child and adolescent.</a> The Annals of Otology, Rhinology, and Laryngology. 105 (4), 267-271 (1996).</li><li>Stack, L. B., Munter, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Foreign+bodies+in+the+gastrointestinal+tract.">Foreign bodies in the gastrointestinal tract.</a> Emergency Medicine Clinics of North America. 14 (3), 493-521 (1996).</li><li>Saz, E. U., Arikan, C., Ozgen&#231;, F., Duyu, M., Ozananar, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+utility+of+handheld+metal+detector+in+confirming+metallic+foreign+body+ingestion+in+the+pediatric+emergency+department.">The utility of handheld metal detector in confirming metallic foreign body ingestion in the pediatric emergency department.</a> The Turkish Journal of Gastroenterology: The Official Journal of Turkish Society of Gastroenterology. 21 (2), 135-139 (2010).</li></ol>

金属异物在儿童中摄取是一个常见的问题, 在大多数患者中, 这是保守的管理7,16。单一或重复的射线照相可以暴露敏感的儿科人群的不必要的辐射风险, 而试图本地化的摄取金属异物。一些研究已经描述了使用金属探测器在 MFB 摄取儿童, 灵敏度超过 96%, 特异性大于 80%1,7,17,<sup...

由于婴儿和儿童的自然好奇性, 通过品尝和吞咽1,2来探索物体, 异物摄取在儿童急诊室中是一个普遍存在的问题。以前的研究报告, 金属物体构成85% 的所有异物 ingestions 在他们的队列的病人3,4。本议定书的目标是评估使用手持金属探测器检测儿童摄取的金属异物的准确性和可行性。我们建议, 通过在对金属异物摄取高度怀疑的儿童的分流过程中及早引入手持金属检测器筛选协议, 被下令定位金属异物的射线照相数量可以减少了这种对无线电敏感的人群。
手持金属探测器 (HHMD) 是一种价格低廉、易于获取的辅助辅料, 可帮助加快对摄取金属异物的管理。金属探测器是一种非常低频的装置, 它有一个接收器和一个发射机, 它能检测到在其附近3的金属物体的存在所引起的电磁场的变化。如果金属物体在磁场中, 电磁场就会中断, 传感器将在设备4上设置视听报警。金属探测器检查可以在不到2分5分钟内彻底完成。因此, HHMD 筛查可以在早期的诊断儿童的分流过程中高怀疑金属异物摄取的地形定位。
硬币是最常见的吞食金属异物1,4,6,7。由于缺乏锋利的边缘和一般无毒的性质, 大多数硬币 ingestions 管理保守。一般摄取的其他类型的材料包括磁铁、纽扣电池、小玩具、花生、首饰、纽扣、骨头、种子和爆米花8、9。异物的冲击最常见发生在食管三处, 即上食管括约肌, 中食管在主动脉弓水平, 下食管括约肌10。金属异物 (MFBs) 位于食管可能是无症状的40% 患者11,12 , 其长期的撞击可能导致各种并发症, 如食管穿孔, 纵隔,气管食管瘘, 气管狭窄, 主动脉食管瘘1,13,14,15。其他部位的异物嵌塞包括幽门, 十二指肠和 ileo-盲肠交界10。
执行颈部、胸部和腹部的射线照相来诊断疑似异物摄取是5紧急部门的普遍做法。在所有被摄取的异物中, 只有10% 是无线电不透明的10。放射检查是耗时的, 并有危险的辐射暴露在儿童。精确的地形定位的摄取金属物体是非常重要的指导治疗。在分流过程早期引入 HHMD 筛查可以通过地形对摄取的金属异物进行定位, 帮助减轻放射摄影的外部排列。
本研究评价了 HHMD 在系统地形学中定位 MFBs 的准确性, 确定了 HHMD 在当地儿科人群中的有效性和可行性。我们还研究了这种辐射免费筛查工具是如何良好的病人和家长接受。在可能和2016年7月之间, 所有连续的患者递交到儿科急诊科以外国身体摄取的历史被包括在研究中。知情同意是从父母或法定监护人那里获得的。使用 HHMD 对指称异物摄取的患者进行系统扫描。对摄取金属异物进行鉴定和定位的金标准是对宫颈区、胸腔和腹部的普通影像。为便于进行研究, 创建了一个标准化的工作流 (图 1)。根据工作流专门创建的日志簿用于收集初始数据, 随后将其转录到电子表格 (图 2)。结果部分中的数据被描述为按百分比显示的事例数。

<table>
	<tbody>
		<tr>
			<td>Hand held metal detector</td>
			<td>Garrett Super Scanner V</td>
			<td>NA</td>
			<td>NA</td>
		</tr>
	</tbody>
</table>

handheld metal detector screening for metallic foreign body ingestion in children

硬币是儿童中最常见的摄取金属异物。本议定书的目标是评估使用手持金属探测器检测儿童摄取的金属异物的准确性和可行性。我们建议, 通过引进手持金属探测器筛查早期的儿童的分流过程中, 高怀疑金属异物摄取, 可以减少的射线照相的数量, 以本地化金属异物可在此无线电敏感的人口。这项研究的议定书要求对参加者进行检查, 以了解外国身体摄取和排除呼吸窘迫或金属植入物患者的病史。病人改变了医院礼服和物品, 可能含有金属如眼镜, 耳环, 挂件, 和装饰品被删除。病人被安置在房间的中心远离其他金属干扰。手持式金属探测器的工作状态首先通过引出一个正面的视听信号来确认。然后, 筛查是在一个直立的位置, 头部延伸, 以揭露颈部, 从下巴水平到髋关节水平, 以前方和向后的曲折方式覆盖解剖区域从颈部到骨盆。在扫描时仔细注意到有金属异物存在的正面视听信号。有关的射线照相根据检测到的金属探测器筛查的区域排序。手持金属探测器能够精确地识别我们研究中摄取的金属异物中的所有硬币。手持式金属探测器不能始终如一地检测非硬币金属异物。该协议说明手持金属探测器在识别和定位硬币和硬币等金属异物方面的准确性。

研究人员为这项观察性研究招募了36名病人。这些病人已向儿科急诊科提交了一份外国身体摄取的病史。其中28例患者有金属异物 ingestions (图 3)。其余的8例患者摄取了非金属异物, 如鱼骨、沙爹棒和塑料纽扣。硬币是最常见的异物摄取类型 (表 1), 其中包括30.5% 的病人。其他最常见的异物, 被摄取包括鱼骨, 玩具零件, 纽扣电池, 金属螺丝。...

Watch this Scientific Journal Video about Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children at JoVE.com

Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children

在这里, 我们提出了一个使用手持金属探测器的协议, 用来筛查那些向儿科急诊医学系提供异物摄取病史的儿童的摄入金属异物。

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