OBJECTIVE: A prospective study to validate the computer-assisted method of measuring palpebral fissure length and philtrum smoothness using digital patient photographs. These are key diagnostic facial features of Fetal Alcohol Syndrome. PARTICIPANTS: Motherisk Program (including Breaking the Cycle), Hospital for Sick Children, Toronto - a clinical, research and teaching program dedicated to antenatal drug, chemical, and disease risk counseling. 40 children referred for FASD assessment, 21 under 4 years old, 19 were 4 years or older. METHODS/ MATERIALS: Facial measurements were obtained directly from the patient by physicians and compared to those obtained by computer software measurement of photographs of the same patient. OUTCOME MEASURES: Palpebral fissure length and philtrum smoothness. RESULTS: The photographic measurements showed shorter palpebral fissure length than the direct measurements when analyzing all children (25.4±2.3 vs .23.2±2.4mm; p<0.0001), and children under four (n=21, 24.7±2.4 vs. 21.6±1.6mm; p<0.0001). The difference for older children (n=19) did not reach statistical significance. The computer found four false positive cases and no false negative cases of clinically short palpebral fissure (sensitivity=100%, specificity=64%). Direct measurement scores for philtrum smoothness were different from the computer's measurements using the frontal view (p=0.0012) but not using the ¾ view. CONCLUSION: The method of computer-assisted measurement tends to underestimate the true length and, hence, over- diagnose short palpebral fissure, especially in children under four years old. This method may serve as a useful fetal alcohol syndrome screening tool.
OBJECTIVE: A prospective study to validate the computer-assisted method of measuring palpebral fissure length and philtrum smoothness using digital patient photographs. These are key diagnostic facial features of Fetal Alcohol Syndrome. PARTICIPANTS: Motherisk Program (including Breaking the Cycle), Hospital for Sick Children, Toronto - a clinical, research and teaching program dedicated to antenatal drug, chemical, and disease risk counseling. 40 children referred for FASD assessment, 21 under 4 years old, 19 were 4 years or older. METHODS/ MATERIALS: Facial measurements were obtained directly from the patient by physicians and compared to those obtained by computer software measurement of photographs of the same patient. OUTCOME MEASURES: Palpebral fissure length and philtrum smoothness. RESULTS: The photographic measurements showed shorter palpebral fissure length than the direct measurements when analyzing all children (25.4±2.3 vs .23.2±2.4mm; p<0.0001), and children under four (n=21, 24.7±2.4 vs. 21.6±1.6mm; p<0.0001). The difference for older children (n=19) did not reach statistical significance. The computer found four false positive cases and no false negative cases of clinically short palpebral fissure (sensitivity=100%, specificity=64%). Direct measurement scores for philtrum smoothness were different from the computer's measurements using the frontal view (p=0.0012) but not using the ¾ view. CONCLUSION: The method of computer-assisted measurement tends to underestimate the true length and, hence, over- diagnose short palpebral fissure, especially in children under four years old. This method may serve as a useful fetal alcohol syndrome screening tool.
Authors: H Eugene Hoyme; Wendy O Kalberg; Amy J Elliott; Jason Blankenship; David Buckley; Anna-Susan Marais; Melanie A Manning; Luther K Robinson; Margaret P Adam; Omar Abdul-Rahman; Tamison Jewett; Claire D Coles; Christina Chambers; Kenneth L Jones; Colleen M Adnams; Prachi E Shah; Edward P Riley; Michael E Charness; Kenneth R Warren; Philip A May Journal: Pediatrics Date: 2016-07-27 Impact factor: 7.124