Validation of the Photographic Method in Fetal Alcohol Spectrum Disorder Screening and Diagnosis

Main Article Content

Marina Avner
Paul Henning
Gideon Koren
Irena Nulman

Keywords

F etal alcohol syndrome, palpebral fissure length, philtrum s moothness, screening tools

Abstract

O b j e c t i ve


A prospective study to v a l i d a t e t he co m pu t e r - ass i s t e d m e t hod of m eas u ri n g pa l peb r al f i ss u r e l en g t h a nd ph i l t r um s m oo t hne s s us i ng d i g i t al p a t i e n t ph o t o g r aph s . T he s e a r e k ey d i a g nos t i c f a c i al f e a t u r es of F e t a l A l coh o l S y nd r o m e . P a r t i c i p a n t s Mo t h e r i sk P r o g r am (i n c l u d i ng B r ea k i ng t he C y c l e ) , H osp i t al f o r S i ck C h il d re n, T o r o n t o - a c l i n i c a l , r es e a r ch and t e ac h i ng p r o g r am ded i ca t ed t o a n t e n a t a l d r u g , che m i ca l , and d i s e ase r i sk coun s e l i n g . 40 ch i l d r en r e f e r r ed f o r F A SD asse s s m ent, 21 u n der 4 y ea r s o l d, 19 w e r e 4 y e a r s or o l de r .


Methods / Materials


Fac i a l m easu r e m en t s w e r e ob t a i ned d ir e c t l y fr om t he pa t i e n t by ph y s i c i a n s and co m pa r ed t o t ho s e ob t a i ned by co m pu t er s o f tw a r e m easu r e m ent of p h o t og r aphs of t he sa m e pa t i e n t .


O u t c o m e M e asu r es


Pa l pe b r a l f i s su r e l e n g t h and ph i l t r um s m oo t hne s s.


R esu l t s


T he p ho t o g r aph i c m easu r e m en t s sho w ed sh o r t er p a l p eb r a l f i ss u r e l en g t h t han t he d i r e c t m easu r e m en t s w hen a n a l yz i ng a l l c h il dr en ( 2 5. 4 ± 2.3 v s . 2 3 . 2 ± 2. 4 m m ; p < 0.0001 ) , and c h i l d r en u n d e r f our ( n = 2 1 , 24.7 ± 2 .4 v s . 21.6 ± 1.6 m m ; p < 0.0001 ) . T he d i f f e r ence f or o l d e r ch i l d r en ( n = 1 9 ) d i d not r each s t a ti s t i c a l s i g n i f i ca n ce. T h e co m pu t er f ound f our f a l se p os i ti v e c ases and no f a l se ne g a t i v e cas e s of c l i n i ca l l y sho r t pa l p e b r a l f i ss u r e ( se n s i t i v it y =100 % , sp e c i f i c i t y = 64 %) . Di r e c t m easu r e m ent sc o r es f o r ph il tr um s m oo t hness w e r e d i f f e r e n t fr om t he co m pu t e r ’ s m eas u r e m en t s u s i ng t h e f r o n t a l v i ew ( p = 0.0 0 12) but not us i ng t he ¾ v i e w .


C onc l u s i on


T he m e t hod of c o m pu t e r - ass i s t e d m easu r e m ent t en d s t o und e r es ti m a t e t h e t r ue l en g t h and, hen c e, o v e r - d i a g nose sh o r t pa l peb r al f i ssu r e , e spe c i a ll y i n c h il d r e n und e r f our y ea r s o l d. T h i s m e t hod m ay se r v e as a use f u l f e t al a l c ohol s y nd r o m e sc r ee n i ng t oo l .

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