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Distress experienced during pediatric VCUGs - a granular, prospective assessment using the brief behavioral distress
Paul G Thacker1, Heather R Collins2, Jeannie Hill3
1Department of Radiology and Radiological Science and Department of Pediatrics, Medical University of South Carolina, MSC 322, 96 Jonathan Lucas St., Charleston, SC, 29425, USA. thackerp@musc.edu.
Insights
Objective evaluation shows voiding cystourethrograms (VCUGs) cause less distress than previously thought, particularly during catheter insertion and full bladder phases. Pretest preparation and child life specialist involvement are effective in managing child distress during VCUGs.
Area of Science:
- Pediatric Radiology
- Child Psychology
Background:
- Controversy exists regarding child distress and sedation needs during voiding cystourethrograms (VCUGs).
- Previous studies often relied on subjective parental reports, limiting objective distress assessment.
- Objective measures are needed to accurately evaluate distress during VCUGs.
Purpose of the Study:
- To objectively evaluate child distress during VCUGs using a validated tool.
- To identify specific phases of the VCUG procedure that cause the most distress.
- To inform sedation and preparation protocols for VCUGs.
Main Methods:
- Prospective study of 26 children (ages 3-7) undergoing VCUGs.
- Utilized the Brief Behavioral Distress Scale for objective distress evaluation.
- Assessed distress across 12 distinct procedural steps.
Main Results:
- Significant distress observed during catheter insertion and full bladder phases.
- Catheter insertion yielded the highest mean distress score, nearly triple that of the full bladder phase.
- Entering the room was more distressing than catheter removal or clothing replacement.
Conclusions:
- VCUGs cause less distress than previously reported, even during peak phases.
- Catheterization distress levels were lower than anticipated, closer to minor distress.
- Findings support the efficacy of pretest preparation and child life specialist involvement.
Background:
In spite of decades of experience with the procedure, controversy persists as to the overall distress experienced by children and the routine need for sedation in children undergoing voiding cystourethrograms (VCUG). Many studies have attempted to address these issues, often divided into one camp that champions routine sedation while another group believes that pretest preparation is often all that is needed. At the root of these issues are some of the limitations of previous studies as most incorporate inherently subjective parental questionnaires to determine distress levels rather than using an objective, unbiased observer.
Objective:
The objective of this study is to use a validated and reliable tool (the brief behavioral distress scale) to objectively evaluate the distress experienced during VCUGs.
Materials And Methods:
A prospective study of 26 children (ages 3-7 years old) was performed by the pediatric radiology department at a large urban academic medical center. Patients were evaluated for distress during 12 separate VCUG steps beginning with the patient entering the room and ending with the clothing being replaced at study completion.
Results:
Using a general linear model (repeated measures analysis of variance (ANOVA)), significant distress was identified during two phases of the examination, catheter insertion (P-values ranging <0.001-0.19) and the full bladder phase (P-values ranging 0.005-0.043). The mean distress score for catheter insertion (mean: 1.38, standard deviation [SD]: 1.098) was nearly three times higher than the next most distressful step, i.e. full bladder (mean: 0.65, SD: 0.745). Additionally, entering the room was perceived as significantly more distressing than the catheter out (P = 0.016) and clothing replacement phase (P = 0.006).
Conclusion:
We find that despite there being significantly increased distress during the catheter insertion and full bladder phases, the distress levels during VCUGs are markedly less than in previous reports. Even the most distressful stage, catheterization, was less stressful than previously reported with levels closer to that of minor distress evinced by comfort-seeking behavior from a parent rather than more significant distress resulting in screaming. Our findings corroborate and expand on the conclusion of the effectiveness of pretest preparation and child life specialist involvement.
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