Improving diagnostic accuracy in clinically ambiguous paediatric appendicitis: a retrospective review of ultrasound and pathology findings with focus on the non-visualised appendix

Kelly, Brendan; Bollard, Stephanie; Weir, Adam; O’Brien, Ciara; Mullen, Dorinda; Kerin, Michael J.; McCarthy, Peter

doi:10.1259/bjr.20180585

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Kelly et al reported in their study that 983 appendectomies were performed of whom only 189 had preoperative ultrasound, and the rest of the patients (80.7%) had no imaging modality. 19 The rate of negative appendectomy is remarkably higher than the literature in this study. The overall negative appendectomy rate is 32%, and this rate rises to 46% within the clinically equivocal group that underwent ultrasound.…”

Section: Discussioncontrasting

confidence: 50%

“…Kelly et al reported in their retrospective study overall, the sensitivity of ultrasound for AA (used in 19% of cases as the first-line imaging) was 72.55% and specificity was 77.01% 19. In our study, "surgeon prediction + US" was used in 70.4% of the study cohort, and US sensitivity and specificity were 62.4% and 57.9%, respectively.…”

mentioning

confidence: 46%

“…The authors accept the need for advanced imaging because of the markedly higher rate of negative appendectomy by saying "CT may well have been underutilized in this cohort". 19 According to the results of the regression analysis, they found that all patients with a visualized appendix, the likelihood of surgical pathology positive for AA was significantly greater if the appendix diameter was 7 mm or greater, an appendicolith was present, inflammatory changes were seen, or the white blood cell count was greater than 10,000/μL. A duration of abdominal pain of three or more days was significantly less likely to be associated with appendicitis in this model.…”

Section: Discussionmentioning

confidence: 78%

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Diagnostic Algorithm in the Pediatric Appendicitis; A Prospective Clinical Study

Bostancı

Güneş

Güney

et al. 2022

Pediatric Practice and Research

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Amaç: Akut apandisit (AA), çocuklarda tanısı birçok hastalıkla karışabilmektedir. Bu da gecikmiş tedaviye neden olmaktadır. Görüntüleme yöntemleri hekimlere tanıda yardımcı olabilmektedir. Çalışmamızda AA tanısını koymada yaklaşımlar neler olabiliri değerlendiriyoruz. Tanısal yaklaşımları üç gruba ayırdık. Bunlar: birinci basamakta sadece cerrahın muayenesi, ikinci basamak olarak cerrahın muayenesi ile birlikte Ultrason (US), üçüncü basamakta da şüpheli kalınan durumlarda Manyetik rezonans görüntülemenin (MRG) kullanılmasıydı. Yöntem: Klinik olarak apandisit şüphesi olan üç yüz altmış bir hasta, tanısal yaklaşım tipine göre prospektif olarak üç gruba ayrıldı. Bulgular: Toplam 51 hastaya sadece cerrah öngörüsü ile tanı konuldu. Hastaların 254'üne sadece US incelemesi yapıldı ve 56 hastaya hem US hem de MRG yapıldı. Tanı grupları dikkate alındığında hem “sadece cerrahın muayenesi” hem de “Cerrahın muayenesi + US + MRI” gruplarının doğruluğu %100 idi. “Cerrahın muayenesi + US” grubu, %59,8 doğruluk oranı ile %62,4'lük bir duyarlılık değeri ortaya koydu. US'nun duyarlılığı ve özgüllüğü sırasıyla %61,0, %65,5 idi. Bu değerler MRG için %100 idi. Kurumsal algoritmamızın duyarlılığı, özgüllüğü %100,0, %94,4, pozitif-negatif tahmin değerleri %94,7, %100 idi. Sonuç: Çocuklarda apandisit tanısı için cerrahın değerlendirmesi ve klinik değerlendirmesi ilk tanı yöntemi olmalıdır. US, cerrahları doğru tanı koymada desteklemek için yararlı bir yöntemdir ve MRG, doğru tanıyı doğrulamak için ek bir yöntem olarak güvenilir olabilir.

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Section: Discussioncontrasting

confidence: 50%

mentioning

confidence: 46%

Section: Discussionmentioning

confidence: 78%

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Diagnostic Algorithm in the Pediatric Appendicitis; A Prospective Clinical Study

Bostancı

Güneş

Güney

et al. 2022

Pediatric Practice and Research

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“…Ultrasound was utilized frequently in the paediatric population at SWHC. Though a useful tool in the diagnosis of appendicitis, low‐volume centres have demonstrated significant non‐concordance between sonographic and pathological findings 36 . We observed a false positive rate of 34%.…”

Section: Discussionmentioning

confidence: 61%

Paediatric negative appendicectomy rates at a regional Western Australian Centre: a five‐year cohort study

Behrendorff

Palan

McKitterick

et al. 2023

ANZ Journal of Surgery

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BackgroundIn acute appendicitis, decision‐making around operative intervention for paediatric patients differs from adults due to a higher weight placed on clinical assessment and reduced rates of cross‐sectional imaging. In regional settings, non‐paediatric emergency doctors, general surgeons, and radiologists usually assess and manage this patient group. Differences have been observed in paediatric negative appendicectomy rates between general and paediatric centres.MethodsA retrospective cohort study was performed, identifying paediatric patients undergoing emergency appendicectomy at the Southwest Health Campus (Bunbury, Western Australia) from 2017 to 2021. The primary outcome measure was histopathology confirming the absence of transmural inflammation of the appendix. In addition, clinical, biochemical and radiological data were collected to identify predictors of negative appendicectomy (NA). Secondary outcome measures were hospital length‐of‐stay and post‐operative complication rates.ResultsFour hundred and twenty‐one patients were identified, of which 44.9% had a negative appendicectomy. Statistically significant associations between female gender, white cell count less than 10 × 109, neutrophil ratio less than 75%, low CRP and NA were observed. NA was not associated with a lower risk of re‐admission or complications compared with appendicectomy for appendicitis.ConclusionsOur centre's NA rate is higher than that observed in the literature at both non‐paediatric and paediatric surgical centres. NA has similar morbidity risk to appendicectomy for uncomplicated appendicitis and offers a timely reminder that diagnostic laparoscopy in children is not benign.

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“…(13,14) Most studies do not recommend age cutoffs for maximum cecal appendix diameter in US diagnosis of appendicitis. (15,16) On top of allowing detailed understanding of abdominal anatomy by virtual dissection, US complies with the ALARA (As Low As Reasonable Achievable) principle, (17) which expresses concern regarding diagnostic imaging and sets standards for use of lowest amounts of radiation. This principle supports the applicability of ultrasonography as a non-ionizing imaging modality that should have priority for abdominal assessment in urgent cases.…”

Section: ❚ Discussionmentioning

confidence: 99%

Ultrasonographic evaluation of cecal appendix diameter in pediatric population

Queiroz¹,

Neto²,

Rahal³

et al. 2022

Einstein (São Paulo)

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Objective: To stratify ultrasound samples in a pediatric population undergoing evaluation for acute appendicitis to examine the variability in cecal appendix diameter, in different age groups, and to determine whether there is a prevalent value for each age group. Methods: A retrospective cross-sectional study with 196 children aged 0 to 15 years. Data were extracted from reports of ultrasound examinations carried out between 2008 and 2015. Children with sonographic diagnosis of appendicitis or other signs of periappendiceal inflammation were excluded. Results: The evaluation of the anteroposterior measurement of the cecal appendix revealed a mean diameter of 4.14mm (standard deviation: 0.93mm; 95%CI: 3.86-4.14). Cecal appendix diameter did not differ significant between age groups. Conclusion: Evaluation of the anteroposterior diameter of the cecal appendix in centimeters in a sample of 196 children aged 0 to15 years revealed a mean diameter of 4.14mm (standard deviation, 0.93mm. There were no significant differences in cecal appendix diameter following stratification by age. Results indicate a single value can be adopted for mean cecal appendix diameter in pediatric populations.

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Improving diagnostic accuracy in clinically ambiguous paediatric appendicitis: a retrospective review of ultrasound and pathology findings with focus on the non-visualised appendix

Cited by 8 publications

References 18 publications

Diagnostic Algorithm in the Pediatric Appendicitis; A Prospective Clinical Study

Diagnostic Algorithm in the Pediatric Appendicitis; A Prospective Clinical Study

Paediatric negative appendicectomy rates at a regional Western Australian Centre: a five‐year cohort study

Ultrasonographic evaluation of cecal appendix diameter in pediatric population

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