Do Traditional or Flavored Tongue Depressors Make for Easier Posterior Oropharynx Exams in Pediatric Patients
Condition: Oropharynx
Study type: Interventional

Summary: 
      Evaluation of the oropharynx is a standard component of a general medical exam for all
      pediatric patients, but is an essential exam in the undifferentiated ill child. Pediatric
      patients are unable to verbalize where they hurt, and a comprehensive evaluation is needed to
      identify the source of fever and illness. Frequently, illnesses will present atypically as
      well, and a patient complaining of abdominal pain may ultimately be diagnosed with
      streptococcus pharyngitis. If the examiner does not evaluate the posterior oropharynx, the
      throat as a cause of abdominal pain is easily overlooked. Additionally, young children are
      prone to infections with pox viruses causing herpangina, hand foot and mouth disease, oral
      thrush. Despite the importance of the posterior oropharynx exam, it can be a source of stress
      and anxiety for both the clinician and pediatric patient when a tongue depressor is used to
      evaluate the posterior oropharynx. However, there are no studies to date that have looked at
      decreasing the difficulty or at decreasing the perceived discomfort associated with the
      poster oropharynx exam in the pediatric patient when a tongue depressor is utilized. Despite
      this paucity of research, there are multiple different flavored and candied tongue depressors
      available for this purpose which may or may not aid in obtaining posterior oropharynx exam
      and decrease the discomfort experienced by the patients.
    

Detailed description: 
      The study design is a prospective, placebo-controlled, randomized controlled trial using a
      convenience sample of 96 pediatric patients presenting for care in the emergency department
      who require an oropharyngeal examination as part of their evaluation. Examinations will be
      performed utilizing either traditional (unflavored) or flavored tongue depressors in a random
      fashion. . Physician/provider investigators will complete a brief survey after each exam as
      to the ease of the exam and the perceived emotional discomfort the exam experienced by the
      subject, both recorded on a visual analog scale. The age and sex of the subject, and the
      education level of the investigator will also be recorded. A single question survey will also
      be provided to the parent/caregiver as to their perception of the discomfort of their child
      during the posterior oropharynx exam using a visual analog scale. Additionally, a single
      question survey will be posed to the subject asking for their discomfort level during the
      exam using the Oucher pediatric pain scale.
    

Intervention name(s): Grape flavored Puritan Junior tongue depressor; Traditional unflavored Puritan Regular Tongue Depressor
Intervention type(s): Device; Device
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: All patients registered for evaluation in the Brooke Army Medical Center Pediatric Emergency Department will be screened by evaluation of age, mental status, physical features and history of immunocompromised by the PI or AI as part of their standard triage and care procedures for their evaluation and treatment in the Emergency Department. Potential participants will be identified by the PI and AI from patients who are registered to be seen by the PI or AI. Potential participants who meet the inclusion criteria and who have none of the exclusion criteria will be approached prior to completion of the posterior oropharynx exam for permission to enroll them in this study.
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Device Feasibility
Keywords: Posterior oropharynx exam; Pediatric; Tongue Depressor; Flavored Tongue Depressor