A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography?

Trout, Andrew T.; Sanchez, Ramon; Ladino-Torres, Maria; Pai, Deepa; Strouse, Peter J.

doi:10.1007/s00247-012-2358-6

Cited by 93 publications

(67 citation statements)

References 32 publications

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“…However the false negative rates for both groups (Table 1) were slightly higher or in line with other studies in the literature [12][13][14]. We also realize that the reported sensitivity in the literature is higher than that reported in our study, 67% versus 88% [15].…”

Section: Journal Of Pediatric Carei Issn 2471-805xcontrasting

confidence: 52%

“…On the other hand, a study of 1,009 US evaluations in pediatric appendicitis found a higher detection rate of the appendix when the study was performed by specialized pediatric sonographers in comparison to general sonographers; however a conclusion of outcome with regard to appendicitis was not addressed [13]. The only patient specific factor that influenced visualization of the appendix reported was body habitus [13].…”

Section: Journal Of Pediatric Carei Issn 2471-805xmentioning

confidence: 99%

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Appendicitis Ultrasound: Comparison Study of the Radiology Resident to the Technologist and Attending

Allaei¹

2016

J Pediatr Care

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Background and objects: Community hospitals and academic centers may not always have a radiologist or sonographer on site, and the responsibility of US performance after hours maybe left to a resident. The purpose of this study was to evaluate a growing concern at our institution that a higher numbers of pediatric CT scans were being conducted overnight for the evaluation of acute appendicitis, as a result of a perception that scans performed by residents were not as accurate as those performed by technologists and/or attending. Materials and methods:573 patients initially evaluated by ultrasound for appendicitis, from April 2008 to March 2014. Studies were distinguished by either resident or technologist and attending (TA) performing the procedure. The junior resident was in the first to third years of training with at least 8 weeks of US experience. Follow-up computed tomography and operative reports were reviewed to determine if appendicitis was later confirmed. Results:Of 462 studies in the pediatric non-pregnant group, ages one to eighteen years, 261 (56.5%) were performed by a junior resident and 201 (43.5%) were performed by the TA group. The sensitivity of diagnosing acute appendicitis in the first ultrasound by the resident and TA groups were 59% and 67%, respectively (p=0.73). Additional testing ordered after a negative initial US was higher in the resident group than the TA group, 85 (39.5%) and 46 (26.4%), respectively (p=0.010). The number of false negatives in the overall, resident and TA groups were 35 (38%), 24 (41%) and 11 (33%), respectively (p=0.68). Conclusion:Although appendicitis US has been traditionally touted as operator dependent, there was no statistical difference in this study between residents and attendings of varying levels of experience. Additionally, more follow up studies were ordered when the initial study was negative and performed by the resident.

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Section: Journal Of Pediatric Carei Issn 2471-805xcontrasting

confidence: 52%

Section: Journal Of Pediatric Carei Issn 2471-805xmentioning

confidence: 99%

Appendicitis Ultrasound: Comparison Study of the Radiology Resident to the Technologist and Attending

Allaei¹

2016

J Pediatr Care

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“…[1][2][3][4][5][6] Despite its advantages, 7 ultrasound (US) by itself has limited diagnostic utility for suspected appendicitis, 8 with the rate of equivocal examinations in some studies approaching 50%. [9][10][11][12] Several scoring systems, including the pediatric appendicitis score (PAS), 13 also do not perform well in isolation at diagnosing appendicitis. [14][15][16][17][18][19][20][21] An intravenous contrast-enhanced computed tomography (CT) scan is currently recommended in children with equivocal screening US results.…”

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confidence: 99%

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Schuh

Langer

Kulik

et al. 2015

Academic Emergency Medicine

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Objectives: The primary objective was to determine the diagnostic accuracy of a serial ultrasound (US) clinical diagnostic pathway to detect appendicitis in children presenting to the emergency department (ED). The secondary objective was to examine the diagnostic performance of the initial and interval US and to compare the accuracy of the pathway to that of the initial US.Methods: This was a prospective cohort study of 294 previously healthy children 4 to 17 years old with suspected appendicitis and baseline pediatric appendicitis scores of ≥2, who were managed with the serial US clinical diagnostic pathway. This pathway consisted of an initial US followed by a clinical reassessment in each patient and an interval US and surgical consultation in patients with equivocal initial US and persistent concern about appendicitis. The USs were interpreted by published criteria as positive, negative, or equivocal for appendicitis. Children in whom this pathway did not rule in or rule out appendicitis underwent computed tomography (CT). Cases with missed appendicitis, negative operations, and CTs after the pathway were considered inaccurate. The primary outcome was the diagnostic accuracy of the serial US clinical diagnostic pathway. The secondary outcomes included the test performance of the initial and interval US imaging studies.Results: Of the 294 study children, 111 (38%) had appendicitis. Using the serial US clinical diagnostic pathway, 274 of 294 children (93%, 95% confidence interval [CI] = 90% to 96%) had diagnostically accurate results: 108 of the 111 (97%) appendicitis cases were successfully identified by the pathway without CT scans (two missed and one CT), and 166 of the 183 (91%) negative cases were ruled out without CT scans (14 negative operations and three CTs). The sensitivity of this pathway was 108 of 111 (97%, 95% CI = 94% to 100%), specificity 166 of 183 (91%, 95% CI = 87% to 95%), positive predictive value 108 of 125 (86%; 95% CI = 79% to 92%), and negative predictive value 166 of 169 (98%, 95% CI = 96% to 100%). The diagnostic accuracy of the pathway was higher than that of the initial US alone (274 of 294 vs. 160 of 294; p < 0.0001). Of 123 patients with equivocal initial US, concern about appendicitis subsided on clinical reassessment in 73 (no surgery and no missed appendicitis). Of 50 children with persistent symptoms, 40 underwent interval US and 10 had surgical consultation alone. The interval US confirmed or ruled out appendicitis in 22 of 40 children (55.0%) with equivocal initial US, with one false-positive interval US. Conclusions:The serial US clinical diagnostic pathway in suspected appendicitis has an acceptable diagnostic accuracy that is significantly higher than that of the initial US and results in few CT scans.

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“…While dedicated paediatric sonographers are more likely than their general counterparts to locate the appendix,32, 33 many children do not present to specialist paediatric departments. Definitive sonographic criteria or techniques that improve accuracy and assist diagnosis would be of particular benefit in these cases.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

Reddan

Corness

Mengersen

et al. 2016

J of Medical Radiation Sci

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Sonography is an important clinical tool in diagnosing appendicitis in children as it can obviate both exposure to potentially harmful ionising radiation from computed tomography scans and the need for unnecessary appendicectomies. This review examines the diagnostic accuracy of ultrasound in the identification of acute appendicitis, with a particular focus on the the utility of secondary sonographic signs as an adjunct or corollary to traditionally examined criteria. These secondary signs can be important in cases where the appendix cannot be identified with ultrasound and a more meaningful finding may be made by incorporating the presence or absence of secondary sonographic signs. There is evidence that integrating these secondary signs into the final ultrasound diagnosis can improve the utility of ultrasound in cases where appendicitis is expected, though there remains some conjecture about whether they play a more important role in negative or positive prediction in the absence of an identifiable appendix.

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A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography?

Cited by 93 publications

References 32 publications

Appendicitis Ultrasound: Comparison Study of the Radiology Resident to the Technologist and Attending

Appendicitis Ultrasound: Comparison Study of the Radiology Resident to the Technologist and Attending

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

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