Brian Coley | Cincinnati Children's Hospital Medical Center (original) (raw)
Papers by Brian Coley
Journal of the American College of Radiology, 2014
Journal of the American College of Radiology : JACR, Jan 4, 2015
Vomiting is a commonly reported symptom in infants less than three months of age. There are a mul... more Vomiting is a commonly reported symptom in infants less than three months of age. There are a multitude of pathologies to consider, both within and outside the gastrointestinal tract. In addition to conducting a thorough history and physical examination, a clinician formulates a reasonable differential diagnosis by consideration of two main factors: the infant's age and the characterization of the vomit as bilious or nonbilious. In this endeavor, the clinician is able to determine if an imaging study is needed and, if so, the urgency of the request. A review of the appropriate imaging evaluation of vomiting infants in the newborn to three-month-old age group is provided by organizing the discussion around the following three clinical scenarios: bilious vomiting, intermittent nonbilious vomiting since birth, and new-onset bilious vomiting. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multi...
ABSTRACT Background: Lung ultrasonography (LUS) is increasingly being used to detect pneumonia in... more ABSTRACT Background: Lung ultrasonography (LUS) is increasingly being used to detect pneumonia in children. Using chest radiograph as a reference standard, studies have found LUS to have >85% sensitivity and specificity in detecting pneumonia. However, the interpreting sonologists have rarely been blinded to clinical information. The objective of this study was to determine the inter-rater reliability among pediatric radiologists blinded to the clinical information, with and without a standardized ultrasound protocol. Methods: LUS performed between January 2011-March 2013 on children 3 months-18 years were included. Five pediatric radiologists were trained on LUS interpretation for signs indicative of pneumonia. Two sets of LUS were read. The first set consisted of 40 LUS that were performed for clinical reasons. These LUS were performed without a standardized protocol to ensure coverage of all portions of the lung. The second set consisted of 15 ultrasounds that were performed using a standardized, evidence-based protocol. Inter-rater reliability was calculated using a kappa statistic. Results: The inter-rater reliability for lung consolidation was fair for standardized LUS (0.40) and for unstandardized LUS (0.36). Interstitial disease had slight to poor agreement regardless of protocol. Pleural effusion had fair inter-rater reliability in the unstandardized set (0.29) but almost perfect reliability in the standardized set (0.82) (Table 1). Conclusion: These preliminary data suggest that standardization of sonogram readings leads to higher inter-rater reliability in detecting pleural effusions in children using LUS. However, reliability, while improved, remained low to moderate for other findings of pneumonia. This may indicate a need for clearer definitions in this relatively new application of LUS. Table 1: Inter-rater reliability of lung ultrasounds using unstandardized and standardized ultrasound protocols* Overall Conclusion Unstandardized LUS Standardized LUS Lobar or Patchy Consolidation 0.36 0.40 Interstitial Disease 0.06 0.16 Pleural Effusion 0.29 0.82 * Classification of the strength of agreement: poor (<0.0); slight (0-0.20); fair (0.21-0.40); moderate (0.41-0.60); substantial (0.61-0.80); almost perfect (0.81-1.0)
Objectives To quantify rates and variation in emergency department (ED) cranial computed tomograp... more Objectives To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization in children with ventricular shunts, estimate radiation exposure, and evaluate the association between CT utilization and shunt revision. Study design Retrospective longitudinal cohort study of ED visits from 2003-2013 in children 0-18 years old with initial shunt placement in 2003. Data were examined from 31 hospitals in the Pediatric Health Information System. Main outcomes were cranial CT performed during an ED visit, estimated cumulative effective radiation dose, and shunt revision within 7 days. Multivariable regression modeled the relationship between patient-and hospital-level covariates and CT utilization. Results The 1319 children with initial shunt placed in 2003 experienced 6636 ED visits during the subsequent decade. A cranial CT was obtained in 49.4% of all ED visits; 19.9% of ED visits with CT were associated with a shunt revision. Approximately 6% of patients received 10CTs,accountingfor37.210 CTs, accounting for 37.2% of all ED visits with a CT. The mean number of CTs per patient varied nearly 20-fold across hospitals; the individual hospital accounted for the most variation in CT utilization. The median (IQR) cumulative effective radiation dose was 7.2 millisieverts (3.6-14.0) overall, and 33.4 millisieverts (27.2-43.8) among patients receiving 10CTs,accountingfor37.210 CTs. Conclusions A CT scan was obtained in half of ED visits for children with a ventricular shunt, with wide variability in utilization by hospitals. Strategies are needed to identify children at risk of shunt malfunction to reduce variability in CT utilization and radiation exposure in the ED. (J Pediatr 2015;167:1382-8). A pproximately 150 000 children in the US rely on a cerebrospinal fluid ventricular shunt to treat hydrocephalus. In children , placement of ventriculoperitoneal (VP) shunts, the most common form of cerebrospinal fluid shunt, has doubled over the last 3 decades. 1 Although VP shunts have dramatically improved survival for children with hydrocephalus, they are associated with high rates of complications, such as mechanical failure and infection, which result in cranial imaging and surgical revision. 2 Children are at highest risk for shunt failure within the first year of placement; shunt revision rates are approximately 40% in the first year, and reach as high as 60% within 10 years, with substantial variation in failure rates across hospitals. 3,4 Children with concern for VP shunt-related complications are frequently evaluated in the emergency department (ED), where cranial computed tomog-raphy (CT) is often used to diagnose shunt malfunction and differentiate malfunction from other conditions. 2,5-8 CT use exposes children to ionizing radiation, and greater cumulative radiation exposure might be associated with a greater incidence of malignancy. 7,9,10 Children with VP shunts represent a particularly vulnerable group, as they often undergo multiple CT scans, and may be exposed to large cumulative radiation doses over the course of their lives. 10 Rapid cranial magnetic resonance imaging (MRI) has recently been explored as an alternative to CT to diagnose shunt malfunction. 11,12 To date,
Http Www Libreriasaulamedica Com, 2010
ABSTRACT LEARNING OBJECTIVES Objective: In this course, participants will be able to: (1) Identif... more ABSTRACT LEARNING OBJECTIVES Objective: In this course, participants will be able to: (1) Identify basic skills, techniques, and pitfalls of freehand invasive sonography, with specific focus on small parts applications; (2) Discuss and perform basic skills involved in breast, musculoskeletal, and head/neck invasive sonography; (3) Perform specific US-guided procedures to include core biopsy, abscess drainage, thyroid biopsy, cyst aspiration, access for sclerotherapy of lymphatic malformations, soft tissue foreign body removal, and joint injection. ABSTRACT
Seminars in Ultrasound Ct and Mri, Aug 31, 2007
Pediat Res, 1999
In mechanically ventilated adults, closed multi-use suction systems (CLOSED) have been reported t... more In mechanically ventilated adults, closed multi-use suction systems (CLOSED) have been reported to increase bacterial airway colonization but not the incidence of pneumonia. Comparisons between CLOSED and traditional (OPEN) system in ventilated newborns ...
Journal of Perinatology
OBJECTIVE: We designed this retrospective study to compare radiologic findings in premature infan... more OBJECTIVE: We designed this retrospective study to compare radiologic findings in premature infants with bronchopulmonary dysplasia (BPD) in whom gram-positive cocci (GPC), gram-negative bacilli (GNB), or Ureaplasma urealyticum were colonized. Another objective was to ...
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
ABSTRACT
The Journal of pediatrics, Jan 13, 2015
To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) uti... more To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization in children with ventricular shunts, estimate radiation exposure, and evaluate the association between CT utilization and shunt revision. Retrospective longitudinal cohort study of ED visits from 2003-2013 in children 0-18 years old with initial shunt placement in 2003. Data were examined from 31 hospitals in the Pediatric Health Information System. Main outcomes were cranial CT performed during an ED visit, estimated cumulative effective radiation dose, and shunt revision within 7 days. Multivariable regression modeled the relationship between patient- and hospital-level covariates and CT utilization. The 1319 children with initial shunt placed in 2003 experienced 6636 ED visits during the subsequent decade. A cranial CT was obtained in 49.4% of all ED visits; 19.9% of ED visits with CT were associated with a shunt revision. Approximately 6% of patients received ≥10 CTs, accoun...
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
The purpose of this study was to describe the imaging and pathologic findings of 2 cases of compl... more The purpose of this study was to describe the imaging and pathologic findings of 2 cases of complex neonatal abdominal masses and to discuss the probable common embryologic etiology of fetus in fetu (FIF) and fetaform teratomas. Two male neonates had complex cystic abdominal masses, 1 of which was diagnosed prenatally, and both had abdominal sonography. One patient also had abdominal computed tomography. Both patients subsequently underwent surgical resection, with pathologic and genetic analysis of these masses. One patient had typical imaging, pathologic, and genetic findings of FIF. The second patient had a well-formed mass that was diagnosed pathologically as a teratoma yet had most of the criteria for FIF that have been set forth in recent embryologic literature. Recent concepts regarding the origin of FIF suggest that it is part of a spectrum of monozygotic twinning gone awry, ranging from conjoined twins at one end to fetaform teratomas at the other. The imaging and pathologic features of these 2 cases serve to reinforce this concept.
ABSTRACT LEARNING OBJECTIVES 1) Identify basic skills, techniques, and pitfalls of freehand invas... more ABSTRACT LEARNING OBJECTIVES 1) Identify basic skills, techniques, and pitfalls of freehand invasive sonography, with specific focus on small part applications. 2) Define and discuss technical aspects, rationale, and pitfalls involved in musculoskeletal, breast, head and neck, and pediatric interventional sonographic care procedures. 3) Successfully perform basic portions of hands-on US-guided procedures in a tissue simulation learning model, to include core biopsy, small abscess coaxial catheter drainage, cyst and ganglion aspiration, lymphatic malformation macrocyst access, soft tissue foreign body removal, and intraarticular steroid injection. 4) Incorporate these component skill sets into further life-long learning for expansion of competency and preparation for more advanced interventional sonographic learning opportunities. ABSTRACT
LEARNING OBJECTIVES 1) Review the imaging features of focal liver lesions. 2) Learn to recognize ... more LEARNING OBJECTIVES 1) Review the imaging features of focal liver lesions. 2) Learn to recognize pediatric hepatic masses and congenital abnormalities. 3) Understand the contributions of different imaging modalities to their evaluation.
LEARNING OBJECTIVES 1) Learn the basics of doppler waveform analysis. 2) Learn to recognize norma... more LEARNING OBJECTIVES 1) Learn the basics of doppler waveform analysis. 2) Learn to recognize normal and abnormal sonographic findings in the pediatric central and peripheral vasculature. ABSTRACT
Journal of the American College of Radiology, 2014
Journal of the American College of Radiology : JACR, Jan 4, 2015
Vomiting is a commonly reported symptom in infants less than three months of age. There are a mul... more Vomiting is a commonly reported symptom in infants less than three months of age. There are a multitude of pathologies to consider, both within and outside the gastrointestinal tract. In addition to conducting a thorough history and physical examination, a clinician formulates a reasonable differential diagnosis by consideration of two main factors: the infant's age and the characterization of the vomit as bilious or nonbilious. In this endeavor, the clinician is able to determine if an imaging study is needed and, if so, the urgency of the request. A review of the appropriate imaging evaluation of vomiting infants in the newborn to three-month-old age group is provided by organizing the discussion around the following three clinical scenarios: bilious vomiting, intermittent nonbilious vomiting since birth, and new-onset bilious vomiting. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multi...
ABSTRACT Background: Lung ultrasonography (LUS) is increasingly being used to detect pneumonia in... more ABSTRACT Background: Lung ultrasonography (LUS) is increasingly being used to detect pneumonia in children. Using chest radiograph as a reference standard, studies have found LUS to have >85% sensitivity and specificity in detecting pneumonia. However, the interpreting sonologists have rarely been blinded to clinical information. The objective of this study was to determine the inter-rater reliability among pediatric radiologists blinded to the clinical information, with and without a standardized ultrasound protocol. Methods: LUS performed between January 2011-March 2013 on children 3 months-18 years were included. Five pediatric radiologists were trained on LUS interpretation for signs indicative of pneumonia. Two sets of LUS were read. The first set consisted of 40 LUS that were performed for clinical reasons. These LUS were performed without a standardized protocol to ensure coverage of all portions of the lung. The second set consisted of 15 ultrasounds that were performed using a standardized, evidence-based protocol. Inter-rater reliability was calculated using a kappa statistic. Results: The inter-rater reliability for lung consolidation was fair for standardized LUS (0.40) and for unstandardized LUS (0.36). Interstitial disease had slight to poor agreement regardless of protocol. Pleural effusion had fair inter-rater reliability in the unstandardized set (0.29) but almost perfect reliability in the standardized set (0.82) (Table 1). Conclusion: These preliminary data suggest that standardization of sonogram readings leads to higher inter-rater reliability in detecting pleural effusions in children using LUS. However, reliability, while improved, remained low to moderate for other findings of pneumonia. This may indicate a need for clearer definitions in this relatively new application of LUS. Table 1: Inter-rater reliability of lung ultrasounds using unstandardized and standardized ultrasound protocols* Overall Conclusion Unstandardized LUS Standardized LUS Lobar or Patchy Consolidation 0.36 0.40 Interstitial Disease 0.06 0.16 Pleural Effusion 0.29 0.82 * Classification of the strength of agreement: poor (<0.0); slight (0-0.20); fair (0.21-0.40); moderate (0.41-0.60); substantial (0.61-0.80); almost perfect (0.81-1.0)
Objectives To quantify rates and variation in emergency department (ED) cranial computed tomograp... more Objectives To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization in children with ventricular shunts, estimate radiation exposure, and evaluate the association between CT utilization and shunt revision. Study design Retrospective longitudinal cohort study of ED visits from 2003-2013 in children 0-18 years old with initial shunt placement in 2003. Data were examined from 31 hospitals in the Pediatric Health Information System. Main outcomes were cranial CT performed during an ED visit, estimated cumulative effective radiation dose, and shunt revision within 7 days. Multivariable regression modeled the relationship between patient-and hospital-level covariates and CT utilization. Results The 1319 children with initial shunt placed in 2003 experienced 6636 ED visits during the subsequent decade. A cranial CT was obtained in 49.4% of all ED visits; 19.9% of ED visits with CT were associated with a shunt revision. Approximately 6% of patients received 10CTs,accountingfor37.210 CTs, accounting for 37.2% of all ED visits with a CT. The mean number of CTs per patient varied nearly 20-fold across hospitals; the individual hospital accounted for the most variation in CT utilization. The median (IQR) cumulative effective radiation dose was 7.2 millisieverts (3.6-14.0) overall, and 33.4 millisieverts (27.2-43.8) among patients receiving 10CTs,accountingfor37.210 CTs. Conclusions A CT scan was obtained in half of ED visits for children with a ventricular shunt, with wide variability in utilization by hospitals. Strategies are needed to identify children at risk of shunt malfunction to reduce variability in CT utilization and radiation exposure in the ED. (J Pediatr 2015;167:1382-8). A pproximately 150 000 children in the US rely on a cerebrospinal fluid ventricular shunt to treat hydrocephalus. In children , placement of ventriculoperitoneal (VP) shunts, the most common form of cerebrospinal fluid shunt, has doubled over the last 3 decades. 1 Although VP shunts have dramatically improved survival for children with hydrocephalus, they are associated with high rates of complications, such as mechanical failure and infection, which result in cranial imaging and surgical revision. 2 Children are at highest risk for shunt failure within the first year of placement; shunt revision rates are approximately 40% in the first year, and reach as high as 60% within 10 years, with substantial variation in failure rates across hospitals. 3,4 Children with concern for VP shunt-related complications are frequently evaluated in the emergency department (ED), where cranial computed tomog-raphy (CT) is often used to diagnose shunt malfunction and differentiate malfunction from other conditions. 2,5-8 CT use exposes children to ionizing radiation, and greater cumulative radiation exposure might be associated with a greater incidence of malignancy. 7,9,10 Children with VP shunts represent a particularly vulnerable group, as they often undergo multiple CT scans, and may be exposed to large cumulative radiation doses over the course of their lives. 10 Rapid cranial magnetic resonance imaging (MRI) has recently been explored as an alternative to CT to diagnose shunt malfunction. 11,12 To date,
Http Www Libreriasaulamedica Com, 2010
ABSTRACT LEARNING OBJECTIVES Objective: In this course, participants will be able to: (1) Identif... more ABSTRACT LEARNING OBJECTIVES Objective: In this course, participants will be able to: (1) Identify basic skills, techniques, and pitfalls of freehand invasive sonography, with specific focus on small parts applications; (2) Discuss and perform basic skills involved in breast, musculoskeletal, and head/neck invasive sonography; (3) Perform specific US-guided procedures to include core biopsy, abscess drainage, thyroid biopsy, cyst aspiration, access for sclerotherapy of lymphatic malformations, soft tissue foreign body removal, and joint injection. ABSTRACT
Seminars in Ultrasound Ct and Mri, Aug 31, 2007
Pediat Res, 1999
In mechanically ventilated adults, closed multi-use suction systems (CLOSED) have been reported t... more In mechanically ventilated adults, closed multi-use suction systems (CLOSED) have been reported to increase bacterial airway colonization but not the incidence of pneumonia. Comparisons between CLOSED and traditional (OPEN) system in ventilated newborns ...
Journal of Perinatology
OBJECTIVE: We designed this retrospective study to compare radiologic findings in premature infan... more OBJECTIVE: We designed this retrospective study to compare radiologic findings in premature infants with bronchopulmonary dysplasia (BPD) in whom gram-positive cocci (GPC), gram-negative bacilli (GNB), or Ureaplasma urealyticum were colonized. Another objective was to ...
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
ABSTRACT
The Journal of pediatrics, Jan 13, 2015
To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) uti... more To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization in children with ventricular shunts, estimate radiation exposure, and evaluate the association between CT utilization and shunt revision. Retrospective longitudinal cohort study of ED visits from 2003-2013 in children 0-18 years old with initial shunt placement in 2003. Data were examined from 31 hospitals in the Pediatric Health Information System. Main outcomes were cranial CT performed during an ED visit, estimated cumulative effective radiation dose, and shunt revision within 7 days. Multivariable regression modeled the relationship between patient- and hospital-level covariates and CT utilization. The 1319 children with initial shunt placed in 2003 experienced 6636 ED visits during the subsequent decade. A cranial CT was obtained in 49.4% of all ED visits; 19.9% of ED visits with CT were associated with a shunt revision. Approximately 6% of patients received ≥10 CTs, accoun...
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine
The purpose of this study was to describe the imaging and pathologic findings of 2 cases of compl... more The purpose of this study was to describe the imaging and pathologic findings of 2 cases of complex neonatal abdominal masses and to discuss the probable common embryologic etiology of fetus in fetu (FIF) and fetaform teratomas. Two male neonates had complex cystic abdominal masses, 1 of which was diagnosed prenatally, and both had abdominal sonography. One patient also had abdominal computed tomography. Both patients subsequently underwent surgical resection, with pathologic and genetic analysis of these masses. One patient had typical imaging, pathologic, and genetic findings of FIF. The second patient had a well-formed mass that was diagnosed pathologically as a teratoma yet had most of the criteria for FIF that have been set forth in recent embryologic literature. Recent concepts regarding the origin of FIF suggest that it is part of a spectrum of monozygotic twinning gone awry, ranging from conjoined twins at one end to fetaform teratomas at the other. The imaging and pathologic features of these 2 cases serve to reinforce this concept.
ABSTRACT LEARNING OBJECTIVES 1) Identify basic skills, techniques, and pitfalls of freehand invas... more ABSTRACT LEARNING OBJECTIVES 1) Identify basic skills, techniques, and pitfalls of freehand invasive sonography, with specific focus on small part applications. 2) Define and discuss technical aspects, rationale, and pitfalls involved in musculoskeletal, breast, head and neck, and pediatric interventional sonographic care procedures. 3) Successfully perform basic portions of hands-on US-guided procedures in a tissue simulation learning model, to include core biopsy, small abscess coaxial catheter drainage, cyst and ganglion aspiration, lymphatic malformation macrocyst access, soft tissue foreign body removal, and intraarticular steroid injection. 4) Incorporate these component skill sets into further life-long learning for expansion of competency and preparation for more advanced interventional sonographic learning opportunities. ABSTRACT
LEARNING OBJECTIVES 1) Review the imaging features of focal liver lesions. 2) Learn to recognize ... more LEARNING OBJECTIVES 1) Review the imaging features of focal liver lesions. 2) Learn to recognize pediatric hepatic masses and congenital abnormalities. 3) Understand the contributions of different imaging modalities to their evaluation.
LEARNING OBJECTIVES 1) Learn the basics of doppler waveform analysis. 2) Learn to recognize norma... more LEARNING OBJECTIVES 1) Learn the basics of doppler waveform analysis. 2) Learn to recognize normal and abnormal sonographic findings in the pediatric central and peripheral vasculature. ABSTRACT