Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED

Kim, Changsun; Kang, Bo Kyeong; Lim, Tae Ho; Oh, Jaehoon; Chee, Youngjoon

doi:10.1016/j.ajem.2015.07.048

Cited by 33 publications

(72 citation statements)

References 20 publications

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“…Articles that only provided the final score with limited or no data on the variables were excluded . Twenty‐one studies were included in our review. The study selection process is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

Benabbas

Hanna

Shah

et al. 2017

Academic Emergency Medicine

166

101

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Presence of AA is more likely in patients with undifferentiated abdominal pain migrating to the RLQ or when cough/hop pain is present in the physical examination. Once AA is suspected, no single history, physical examination, laboratory finding, or score attained on PAS can eliminate the need for imaging studies. Operating characteristics of ED-POCUS are similar to those reported for RUS in literature for diagnosis of AA. In ED patients suspected of AA, a positive ED-POCUS is diagnostic and obviates the need for CT or MRI while negative ED-POCUS is not enough to rule out AA.

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Section: Resultsmentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

Benabbas

Hanna

Shah

et al. 2017

Academic Emergency Medicine

166

101

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“…When grouped by modality, there were nine articles on US, composed of six articles on 548 children (9,11,(32)(33)(34)(35) and three articles on 169 adults (36)(37)(38); 20 articles on CT, composed of nine articles on 1498 children (9,26,(39)(40)(41)(42)(43)(44)(45) and 11 articles on 1027 adults (25,37,(46)(47)(48)(49)(50)(51)(52)(53)(54); and 11 articles on MRI, composed of five articles on 287 children (39,(55)(56)(57)(58), one article on 223 adults (59), and five articles on 204 pregnant women (for a total of 427 patients) (24,(60)(61)(62)(63). Figure 1 shows the article selection process.…”

Section: Literature Search and Article Selectionmentioning

confidence: 99%

“…In these studies, the second-line diagnostic imaging modality was often performed when the initial US was equivocal; in six of these studies, (25,40,47,52,58,62), second-line imaging was also performed after a negative result at US. Other studies followed an a priori-determined pathway in which second-line imaging was performed in all participants regardless of the results of the initial US (34)(35)(36)(37)(38)41,44,45,49,54,56,59,60). It is expected that studies that used a conditional imaging pathway would have a lower accuracy of the second-line modality because only patients with appendices that were difficult to view at US would undergo reimaging.…”

Section: Quality Assessment Of Selected Articlesmentioning

confidence: 99%

Acute Appendicitis: A Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US

Eng¹,

Abadeh

Ligocki³

et al. 2018

Radiology

102

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Purpose To evaluate the sensitivity, specificity, and diagnostic odds ratios of US, CT, and MRI as second-line imaging modalities after initial US for assessing acute appendicitis in children and adults. Materials and Methods A literature search was conducted in Medline and Embase to identify articles that used surgery or histopathologic examination alone or in combination with clinical follow-up or chart review to evaluate the diagnostic accuracy of second-line imaging modalities. The quality of articles was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2 and the Standards for Reporting of Diagnostic Accuracy tools. Results For studies of children, the number of studies and patients were as follows: US, six studies and 548 patients; CT, nine studies and 1498 patients; MRI, five studies and 287 patients. For studies of adults, the number of studies and patients were as follows: US, three studies and 169 patients; CT, 11 studies and 1027 patients; MRI, six studies and 427 patients. Pooled sensitivities and specificities of second-line US for diagnosis of appendicitis in children were 91.3% (95% confidence interval [CI]: 83.8%, 95.5%) and 95.2% (95% CI: 91.8%, 97.3%), respectively; and in adults, the pooled sensitivities and specificities were 83.1% (95% CI: 70.3%, 91.1%) and 90.9% (95% CI: 59.3%, 98.6%), respectively. Regarding second-line CT in children, the pooled sensitivities and specificities were 96.2% (95% CI: 93.2%, 97.8%) and 94.6% (95% CI: 92.8%, 95.9%); and in adults, the pooled sensitivities and specificities were 89.9% (95% CI: 85.4%, 93.2%) and 93.6% (95% CI: 91.2%, 95.3%), respectively. Regarding second-line MRI in children, pooled sensitivities and specificities were 97.4% (95% CI: 85.8%, 100%) and 97.1% (95% CI: 92.1%, 99.0%); and in adults, the pooled sensitivities and specificities were 89.9% (95% CI: 84.8%, 93.5%) and 93.6% (95% CI: 90.9%, 95.5%), respectively. Conclusion Second-line US, CT, and MRI have comparable and high accuracy in helping to diagnose appendicitis in children and adults, including pregnant women. All three modalities may be valid as second-line imaging in a clinical imaging pathway for diagnosis and management of appendicitis.

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“…Accuracy of emergency medicine resident-performed POCUS interpreted in real time by a remote expert was high and similar (sensitivity 100 %, specificity 98 %, positive predictive value 95 %, negative predictive value 100 %) to that of onsite expert-performed ultrasonography [30]. …”

Section: Diagnostic Applications Of Ultrasoundmentioning

confidence: 99%

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

et al. 2016

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The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

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Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED

Cited by 33 publications

References 20 publications

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

Diagnostic Accuracy of History, Physical Examination, Laboratory Tests, and Point‐of‐care Ultrasound for Pediatric Acute Appendicitis in the Emergency Department: A Systematic Review and Meta‐analysis

Acute Appendicitis: A Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

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