title: Distress experienced during pediatric VCUGs - a granular, prospective assessment using the brief behavioral distress scale.
abstract: 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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors: Department 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.
authors: Paul G
authors: PG
authors: Thacker
authors: Department of Radiology and Radiological Science, Medical University of South Carolina, MSC 322, 96 Jonathan Lucas St., Charleston, SC, 29425, USA.
authors: Heather R
authors: HR
authors: Collins
authors: Department of Radiology and Radiological Science and Department of Pediatrics, Medical University of South Carolina, MSC 322, 96 Jonathan Lucas St., Charleston, SC, 29425, USA.
authors: Jeannie
authors: J
authors: Hill
mesh_terms: D002648:Child; D002653:Child Behavior Disorders / Q000523:psychology*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011446:Prospective Studies; D013315:Stress, Psychological / Q000517:prevention & control* / Q000523:psychology*; D014554:Urination; D014555:Urination Disorders / Q000000981:diagnostic imaging*; D014567:Urography / Q000523:psychology*
keywords: Brief behavioral distress scale; Children; Distress; Midazolam; Sedation; Voiding cystourethrogram