Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs

Reddan, Tristan; Corness, Jonathan; Harden, Fiona; Mengersen, Kerrie

doi:10.14366/usg.17062

Cited by 25 publications

(27 citation statements)

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“…Tristan R et al saw appendicitis out of 230 number in 68.7%cases, mark improvement with negative appendectomy rate of 8.7% and with secondary signs increase sensitivity [ 12 , 18 ]. The rate of visualization of the appendix by ultrasound has varied widely in the literature.…”

Section: Discussionmentioning

confidence: 99%

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

Khan

Kitar

Krichen

et al. 2019

Annals of Medicine and Surgery

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BackgroundTo determined the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard.MethodsA prospective evaluations of all ultrasound for appendicitis from January 1, 2014, to June 15, 2017, was conducted at our hospital. A diagnostic protocol was implemented to reduce radiation exposure employing US as the initial imaging modality followed by CT for non-diagnostic US studies in patients with an equivocal clinical presentation. The imaging, operative findings, and pathology of 223 patients (females 80, males 143, age less than 14years) with diagnosed appendicitis were collected. The sensitivity, specificity, predictive value, and negative appendectomy rate were also analyzed. All those patients which had subjected to surgery were included to evaluate the true result of ultrasound in diagnosis of appendicitis.ResultsOf the 223 pediatric appendectomies performed in this time period, a total of 192 (86%) were diagnosed by ultrasound. The histopathology of 8 was normal (3.6%), CT done in 11 and three was normal. The negative appendectomy rate was 3.6%. US were the sole imaging modality in all patients.ConclusionsIn the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure.Study designcross sectional validation.

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Section: Discussionmentioning

confidence: 99%

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

Khan

Kitar

Krichen

et al. 2019

Annals of Medicine and Surgery

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“…While presence of echogenic mesentery was most accurate in combination with diameter, its absence in cases where the appendix was non‐visualised had an NPV of 95.3%, emphasising the role of sonography in negative prediction of appendicitis in cases of non‐visualisation . Given the low sonographic visualisation rates in many studies, awareness and incorporation of a variable that does not rely on identification of the appendix is of high clinical importance.…”

Section: Discussionmentioning

confidence: 99%

“…Data evaluated in this study were pooled from two previous projects, one retrospective and one prospective in the same patient population in Australia. Patients under 16 years of age who were referred for ultrasound examination for suspected appendicitis were included.…”

Section: Methodsmentioning

confidence: 99%

“…While some studies have demonstrated that the appendix can almost invariably be found in children with ultrasound, many centres are only able to achieve visualisation rates of around 50% or lower . Improved visualisation can result by providing training in appendix ultrasound techniques to sonographers performing these studies . Cases where the appendix cannot be identified have historically been considered non‐diagnostic or equivocal.…”

Section: Introductionmentioning

confidence: 99%

“…[4][5][6] Improved visualisation can result by providing training in appendix ultrasound techniques to sonographers performing these studies. 7 Cases where the appendix cannot be identified have historically been considered non-diagnostic or equivocal. These cases are made more meaningful with the exclusion, or recognition and evaluation of secondary signs of appendicitis.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms

et al. 2018

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Introduction We evaluated the predictive value of sonographic and clinical variables in the diagnosis of acute appendicitis in children using decision tree modelling. Methods Data pooled from two prior studies in the same population of children referred for ultrasound examination of suspected acute appendicitis. Ultrasound and clinical variables were collated and compared with patient records. Decision tree algorithms were used to model data to identify highly discriminatory variables. Receiver operative characteristic (ROC) curve analyses were performed on different models of appendiceal diameter criteria. Results There were 687 examinations included. Diameter modelling indicated that categorical assessment – below 6 mm as negative, diameters between 6 and 8 mm equivocal for appendicitis and above 8 mm positive – was more accurate (AUROC = 0.921) than the most accurate binary cut‐off (7 mm, AUROC = 0.886). Decision tree analysis supported categorical diameter criteria, demonstrated that the presence of echogenic mesentery was an important variable and showed that common blood test results can be complementary discriminators of ultrasound findings. Discussion The use of a binary appendiceal diameter cut‐off was less accurate than a three‐category model. Absence of peri‐appendiceal mesentery inflammation is an important negative predictor of appendicitis in children, even without direct visualisation of the appendix.

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Paediatric appendiceal ultrasound: a survey of Australasian sonographers’ opinions on examination performance and sonographic criteria

Reddan

Corness

Harden

et al. 2018

J of Medical Radiation Sci

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IntroductionThe objectives of this study were to identify knowledge gaps and/or perceived limitations in the performance of paediatric appendiceal ultrasound by Australasian sonographers. We hypothesised that: sonographers’ confidence in visualising the appendix in children was poor, particularly outside predominantly paediatric practice; workplace support for prolonging examinations to improve visualisation was limited; and the sonographic criteria applied in diagnosis did not reflect contemporary literature.MethodsA cross‐sectional survey of Australasian sonographers regarding paediatric appendicitis was conducted using a mixed methods approach (quantitative and qualitative data). Text responses were analysed for key themes, and quantitative data analysed using chi‐square, Mann–Whitney U and Wilcoxon signed‐rank tests.ResultsOf the 124 respondents, 27 (21.8%) reported a visualisation rate of less than 10%. Workplace support for extending examination time was significantly related to a higher appendix visualisation rate (χ 2(2) = 16.839, P < 0.001). Text responses reported frustration locating the appendix and a desire for more time and practice to improve visualisation. Sonographers suggested a significantly lower maximum diameter cut‐off in a 5‐year‐old compared to a 13‐year‐old (Z = −6.07, P < 0.001), and considered the presence of inflamed peri‐appendiceal mesentery as the most useful sonographic criterion in diagnosing acute appendicitis.ConclusionsRespondents had a low opinion of their ability to confidently identify the appendix. Confidence was greater in those centres where extending scanning time was encouraged. Application of echogenic mesentery as the most significant secondary sonographic criterion is supported by recent studies. Opinions of diameter cut‐offs varied, indicating potential for improved awareness of recent research.

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Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs

Abstract: Engagement of sonographers performing pediatric appendiceal ultrasound through training in the scanning technique and awareness of secondary signs significantly improved the visualization rate and provided more meaningful findings to referrers.

Cited by 25 publications

References 25 publications

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms

Paediatric appendiceal ultrasound: a survey of Australasian sonographers’ opinions on examination performance and sonographic criteria

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