Lei Chen MD

Associate Professor of Pediatrics (Emergency Medicine); Director of Research, Pediatric Emergency Medicine

Research Interests

Emergency ultrasound; Ethics and subject protection; Student, resident and fellow education; Serious bacterial infections in infants; Pediatric resuscitations

Current Projects

Pediatric Emergency Medicine Program Director

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Research Summary

I am committed to a career in Health Services Research as a means to improve the care of children in the acute care setting. My short-term goal is to gain additional knowledge in health care management and policy and in assessing cost-effectiveness as well as efficiency of clinical interventions based on emerging technologies. My long-term career goal is to develop the expertise to design, to implement, and to evaluate the clinical and public health effectiveness of interventions that employ new emerging technologies for the acute care of children.

I have focused on the application of new technology to improve the care of pediatric patients in the emergency department. Broadly speaking these projects have one or both of the following goals:

• increase efficiency of medical care;
• enhancing the safety of the patients during the delivery of medical care.

Bedside ultrasound prior to urethral catheterization in infants

In this project we used bedside ultrasound to increase the success rate of bladder catheterization in infants. Due to significant electronic miniaturization, high quality portable ultrasound units became available in the early 2000’s. Prior to our study there was a dearth of research on the use of the modality in the care of children in emergency departments. Using a simple noninvasive technique we were able to increase the success rate of the invasive procedure from 75% to 93%, thereby decreasing the cost of medical care and improving the safety and comfort of the patients undergoing the procedure. This technique is currently in wide use across the country.

Extensive Research Description

I am committed to a career in Health Services Research as a means to improve the care of children in the acute care setting. My short-term goal is to gain additional knowledge in health care management and policy and in assessing clinical and cost-effectiveness as well as efficiency of clinical interventions based on emerging technologies. My long-term career goal is to develop the expertise to design, to implement, and to evaluate the clinical and public health effectiveness of interventions that employ new emerging technologies for the acute care of children.

During the past several years I have focused on the application of new technology to improve the care of pediatric patients in the emergency department. Broadly speaking these projects have one or both of the following goals; 1) increase efficiency of medical care; and 2) enhancing the safety of the patients during the delivery of the medical care. Bedside ultrasound prior to urethral catheterization in infants In this project we used bedside ultrasound to increase the success rate of a common procedure: bladder catheterization in infants. Due to significant electronic miniaturization high quality portable ultrasound units became available in the early 2000’s. Prior to our study there was a dearth of research on the use of the modality in the care of children in emergency departments. Using a simple noninvasive technique we were able to increase the success rate of the invasive procedure from 75% to 93%(2), thereby decreasing the cost of medical care and improving the safety and comfort of the patients undergoing the procedure. This technique has been duplicated by others across the country(3) and is currently in wide use.

Camera phone as a tool for telemedicine

Another project was also aimed at increasing the efficiency of care. The new technology used was cellular phones with built-in cameras. We hypothesized that parents can use this widely-available technology to transmit images to physicians, who can better recommend appropriate treatment strategies, ranging from routine wound care at home to repair by subspecialists. Indeed in our study of 69 patients who presented for wound repairs, 20% only required local wound care(4). Most of these were identified remotely using camera-phone images. Adoption of this technology could result in substantial savings in medical care costs.

Use of laryngeal mask airway in pre-hospital pediatric resuscitations Children who suffer cardiopulmonary arrest in the pre-hospital setting have almost uniformly poor outcomes. There is evidence that early establishment of effective oxygenation is associated with better survival. Yet proficiency in airway management in children is difficult to acquire and maintain, especially for pre-hospital providers for whom pediatric experiences are generally rare. The laryngeal mask airway (LMA) is a relatively new device in children. In a randomized trial we utilized high-fidelity human patient simulators as a platform to test our hypothesis that the LMA, despite its novelty, compared favorably to the established standard, the endotracheal tube. In our study of 52 pre-hospital providers, the time required to establish effective oxygenation was less than half while using the LMA as compared to the endotracheal tube(5). Subsequent to our study many emergency medical services locales are equipping their ambulances with pediatric-sized LMA’s.

Forearm fractures

Forearm fractures are common injuries in children. Displaced and angulated fractures often require reduction under fluoroscopy. Ultrasound diagnosis and guided reduction offer several potential advantages: 1) The procedure does not involve ionizing radiation; 2) Bedside studies can be obtained quickly. In our research project we investigated the test characteristics of ultrasound diagnosis of forearm fractures. For the 68 patients enrolled the sensitivity for the detection of forearm fractures was 97% using ultrasound. The specificity was 100%(6). Twenty-six subjects underwent ultrasound-guided reduction of their fractures in the ED, with an initial success rate of 92%. Adoption of ultrasound-guided reduction would likely lead to less exposure to ionizing radiation as compared to fluoroscopy.

Ultrasound in infant lumbar punctures

The lumbar puncture is a common procedure in the pediatric emergency department. Children are usually restrained in various positions to facilitate the procedure. The purpose of this study was to measure the interspinous space, using ultrasound, to determine an optimal position for children undergoing lumbar punctures where the interspinous space was maximized. The results showed that the “sitting flexed” position provided a significantly increased interspinous space as compared to the other positions Flexion of the neck, however, did not significantly change the interspinous space. Knowledge of this fact will likely lead to increased success rates and decreased respiratory distress in infants(7).

Noninvasive assessment of intravascular volume in dehydration

Dehydration from gastroenteritis is another common condition encountered in the emergency department. In order to tailor appropriate intervention it is important to assess the severity of the dehydration. This is difficult in the acute care setting. Therefore many children undergo intravenous rehydration who may otherwise be safely managed with oral rehydration. We performed two projects demonstrating that ultrasound measurements of the inferior vena cava (IVC) was an objective assessment of intravascular volume in children(8). Incorporating the findings of our research would likely lead to more efficient utilization of health care resources by tailoring the treatment to the severity of illness.

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Selected Publications