Diagnostic value of maximal-outer-diameter and maximal-mural-thickness in use of ultrasound for acute appendicitis in children

Je, Bo-Kyung; Kim, Sung-Bum; Lee, Seung Hwa; Lee, Ki Yeol; Hoon, Sang

doi:10.3748/wjg.15.2900

Cited by 35 publications

(20 citation statements)

References 16 publications

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“…Very high CRP levels may have a relation with the appendicitis being gangrenous. (19). Similar to these studies, we found in our study a statistically meaningful relationship between acute appendicitis and appendix diameter longer than 5 mm.…”

Section: Discussionsupporting

confidence: 92%

The place of scoring systems for the diagnosis of acute appendicitis a retrospective cohort study

Namdaroğlu¹,

Öter²,

Karabeyoglu³

2018

J Turgut Ozal Med Cent

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Aim: Acute appendicitis is among the most frequently observed reasons of abdominal pain. The high rate of dubiousness in diagnosis, high rate of negative appendectomy led to the introduction of scoring systems. Despite today's advanced imaging methods and various scoring methods like Alvarado, making the diagnosis may not always be easy. On the other hand, negative appendectomy rate is reported to be 15-30%. Therefore accurate and rapid diagnosis is fundamental in acute appendicitis. In our study we aimed to determine the place of scoring systems defined by Alvarado, Ohmann and Eskelinen for the diagnosis of acute appendicitis and their efficacy in lowering negative appendectomy rates. Material and Methods: In our study, 120 patients who were operated as a result of diagnosis of acute appendicitis between May-2011 and July-2011 were retrospectively evaluated. Patients' Alvarado, Ohmann and Eskelinen scores were calculated for evaluation. Result: It was seen that there was a statistically significant between high Alvarado and Ohmann scores and pathological acute appendicitis. Considering Eskelinen score, significant difference could not be determined. Discussion: In conclusion, Alvarado, Ohmann and Eskelinen scoring systems were evaluated with regard to acute appendicitis and found a meaningful relationship between Alvarado and Ohmann scoring systems and the acute appendicitisit is thought that the use of the scoring system especially for children and the elder would decrease negative appendectomy and perforations. In addition, its coefficients which create a calculation difficulty in practical use limit the use of this scoring system in emergencies which work intensively.

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Section: Discussionsupporting

confidence: 92%

The place of scoring systems for the diagnosis of acute appendicitis a retrospective cohort study

Namdaroğlu¹,

Öter²,

Karabeyoglu³

2018

J Turgut Ozal Med Cent

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“…[2,[21][22][23] Chen et al [21] found that BUS had a sensitivity of 96.4% and a specificity of 67.6% for the diagnosis of appendicitis, compared to a sensitivity of 86.2% and a specificity of 37% based on surgeons' clinical judgment. However, the prevalence of appendicitis was 75% in their study and all physician sonographers had extensive BUS experience, reflecting a setting atypical for most EDs.…”

Section: Discussionmentioning

confidence: 99%

“…This is largely in line with the current radiology literature. Je et al [23] determined that the optimal appendix diameter and wall thickness cut-off value for diagnosis of pediatric appendicitis were 5.7 mm and 2.2 mm, respectively. In another study, Van Randen et al [24] found thickened a p p e n d i x ( > 6 m m ) , t r a n s d u c e r t e n d e r n e s s a n d periappendiceal fat infi ltration to be signifi cant variables predicting ultrasound diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 99%

Application of scoring systems with point-of-care ultrasonography for bedside diagnosis of appendicitis

Ünlüer

Urnal

Eser

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND: Appendicitis is a common disease requiring surgery. Bedside ultrasound (BUS) is a core technique for emergency medicine (EM). The Alvarado score is a well-studied diagnostic tool for appendicitis. This study aimed to investigate the relationship between patients' symptoms, Alvarado score and ultrasound (US) findings, as performed by emergency physicians (EPs) and radiologists, of patients with suspected appendicitis. METHODS:Three EM specialists underwent the BUS course and core course for appendicitis assessment. Patients suspected of having appendicitis were selected and their Alvarado and modifi ed (m) Alvarado scores calculated. The specialists performed the BUS. Then, patients were given a formal US and surgery consultation if necessary. Preliminary diagnoses, admission or discharge from the emergency department (ED) and fi nal diagnosis were documented. The patients were also followed up after discharge from the hospital. RESULTS:The determined cut-off value was 2 for Alvarado and 3 for mAlvarado scores. The sensitivities of the two scores were 100%. Each score was used to rule out appendicitis. The results of EP-performed BUS were as follows: accuracy 70%, sensitivity 0.733, specifi city 0.673, + LR 2.24, and -LR 0.40 (95%CI). Radiologists were better than EPs at diagnosing appendicitis and radiologists and EPs were equally strong at ruling out appendicitis by US. When US was combined with Alvarado and mAlvarado scores, EP US+Alvarado/mAlvarado scores ≤3 and radiology US+Alvarado/ mAlvarado scores ≤4 perfectly ruled out appendicitis.CONCLUSION: BUS performed by EPs is moderately useful in detecting appendicitis. Combined with scoring systems, BUS may be a perfect tool for ruling out decisions in EDs.

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“…The ACT diagnosis of acute appendicitis has usually been based on the visualization of an appendix .6 mm in maximal diameter, with contrast enhancement in the thickened appendiceal wall and/or pericecal inflammatory changes, or on the visualization of an abscess, with or without an appendicolith; 13 one study has described the imaging features of USG and ACT for negative appendectomies in children. 8 Taylor et al 14 concluded that isolated ACT findings of an appendicolith without an inflammatory sign or minimal fat stranding were not sufficient signs for the diagnosis of appendicitis. Trout et al 15 showed that nonvisualization of the appendix was not related to accurate diagnosis of appendicitis because the smaller volume of intra-abdominal fat in children may contribute to the relatively low rate of normal appendix detection at ACT.…”

Section: Discussionmentioning

confidence: 99%

“…Wall thickness was measured from the luminal surface to the serosal layer and was considered to be thickened if it measured .2.2 mm. 8 Lymphadenopathy was defined as an enlarged node measuring .8 mm at its smallest diameter. 9 …”

Section: Assessment Of Act Findingsmentioning

confidence: 99%

Inconclusive abdominal CT findings in pediatric patients with appendicitis: lessons from negative appendectomy cases

Kim¹,

Moon²

2016

RMI

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Purpose: Although abdominal computed tomography (ACT) has high sensitivity and specificity in helping to detect appendicitis in pediatric patients, diagnostic challenges still exist for some cases despite undergoing ACT, and negative appendectomies still persist. The aim of this study was to elucidate some ACT findings that support true appendicitis for patients who had inconclusive preoperative ACT findings. Patients and methods: For the 49 patients whose preoperative ACT diagnoses were inconclusive (ten negative appendicitis; 39 true appendicitis), the ACT findings were retrospectively measured for the following features: appendiceal enlargement, presence of appendicolith or hyperdense materials in the appendix, periappendiceal fat inflammation, periappendiceal fluid collection, appendiceal wall thickening, appendiceal gas, and right lower quadrant lymphadenopathy. These features were compared between true appendicitis and negative appendicitis cases. Results: The presence of an enlarged appendix of diameter .8 mm or periappendiceal fat inflammation strongly correlated with true appendicitis, while the absence of appendiceal wall thickening or mesenteric lymphadenopathy correlated with negative appendicitis. Conclusion: If the ACT findings were inconclusive for patients suspected of having appendicitis, factors such as periappendiceal fat inflammation, an enlarged appendix, appendiceal wall thickening, and mesenteric lymphadenopathy should be cautiously assessed to discriminate true appendicitis from negative appendicitis.

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Diagnostic value of maximal-outer-diameter and maximal-mural-thickness in use of ultrasound for acute appendicitis in children

Abstract: The MOD and the MMT are reliable criteria to diagnose acute appendicitis in children. An MOD > 0.57 cm and an MMT > 0.22 cm are the optimal criteria.

Cited by 35 publications

References 16 publications

The place of scoring systems for the diagnosis of acute appendicitis a retrospective cohort study

The place of scoring systems for the diagnosis of acute appendicitis a retrospective cohort study

Application of scoring systems with point-of-care ultrasonography for bedside diagnosis of appendicitis

Inconclusive abdominal CT findings in pediatric patients with appendicitis: lessons from negative appendectomy cases

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