National estimates of hospital utilization by children with gastrointestinal disorders: analysis of the 1997 kids' inpatient database

Guthery, Stephen L.; Hutchings, Caroline; Dean, J. Michael; Hoff, Charles

doi:10.1016/j.jpeds.2004.02.029

Cited by 86 publications

(54 citation statements)

References 10 publications

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“…Appendicitis is the most common indication for acute abdominal surgery in children. 1 In the United States, .70 000 children aged #18 years are diagnosed with appendicitis annually. The incidence is highest in boys aged 10 to 14 years and in girls aged 15 to 19 years.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography/MRI Versus CT for Diagnosing Appendicitis

Aspelund¹,

Fingeret²,

Gross³

et al. 2014

Pediatrics

135

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WHAT'S KNOWN ON THIS SUBJECT: Previous studies have confirmed feasibility of MRI for diagnosis of appendicitis in adults and children. No study has assessed clinical end points when using ultrasound and MRI compared with computed tomography for diagnosis of appendicitis in children.WHAT THIS STUDY ADDS: Radiation-free imaging with ultrasound selectively followed by MRI does not change clinical endpoints compared with CT for diagnosing appendicitis in children, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay. abstract BACKGROUND: Cross-sectional imaging increases accuracy in diagnosing appendicitis. We hypothesized that a radiation-free imaging pathway of ultrasonography selectively followed by MRI would not change clinical end points compared with computed tomography (CT) for diagnosis of acute appendicitis in children. METHODS:We retrospectively reviewed children (,18 years old) who had diagnostic imaging for suspected acute appendicitis between November 2008 and October 2012. Before November 2010 CT was used as the primary imaging modality (group A); subsequently, ultrasonography was the primary imaging modality followed by MRI for equivocal findings (group B). Data collected included time from triage to imaging and treatment and results of imaging and pathology.RESULTS: Six hundred sixty-two patients had imaging for suspected appendicitis (group A = 265; group B = 397, of which 136 [51%] and 161 [41%], respectively, had positive imaging for appendicitis). Negative appendectomy rate was 2.5% for group A and 1.4% for group B. Perforation rate was similar for both groups. Time from triage to antibiotic administration and operation did not differ between groups A and B. There was higher proportion of positive imaging and appendectomies in group A and thus more negative imaging tests in group B (ultrasonography and MRI), but diagnostic accuracy of the 2 imaging pathways was similar. CONCLUSIONS:In children with suspected acute appendicitis, a radiationfree diagnostic imaging of ultrasonography selectively followed by MRI is feasible and comparable to CT, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay.

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Section: Discussionmentioning

confidence: 99%

Ultrasonography/MRI Versus CT for Diagnosing Appendicitis

Aspelund¹,

Fingeret²,

Gross³

et al. 2014

Pediatrics

135

View full text Add to dashboard Cite

show abstract

“…1,2 Appendicitis remains difficult to diagnose and the source of considerable health care expense. 2,3 Clinicians frequently use abdominal computed tomography (CT) to evaluate children for possible appendicitis despite concerns related to the risks of radiation exposure. 4 Substantial controversy exists among experts regarding the optimal diagnostic approach to children with acute abdominal pain.…”

mentioning

confidence: 99%

Interrater Reliability of Clinical Findings in Children With Possible Appendicitis

et al. 2012

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OBJECTIVE: Our objective was to determine the interrater reliability of clinical history and physical examination findings in children undergoing evaluation for possible appendicitis in a large, multicenter cohort. METHODS: We conducted a prospective, multicenter, cross-sectional study of children aged 3–18 years with possible appendicitis. Two clinicians independently evaluated patients and completed structured case report forms within 60 minutes of each other and without knowing the results of diagnostic imaging. We calculated raw agreement and assessed reliability by using the unweighted Cohen κ statistic with 2-sided 95% confidence intervals. RESULTS: A total of 811 patients had 2 assessments completed, and 599 (74%) had 2 assessments completed within 60 minutes. Seventy-five percent of paired assessments were completed by pediatric emergency physicians. Raw agreement ranged from 64.9% to 92.3% for history variables and 4 of 6 variables had moderate interrater reliability (κ > .4). The highest κ values were noted for duration of pain (κ = .56 [95% confidence intervals .51–.61]) and history of emesis (.84 [.80–.89]). For physical examination variables, raw agreement ranged from 60.9% to 98.7%, with 4 of 8 variables exhibiting moderate reliability. Among physical examination variables, the highest κ values were noted for abdominal pain with walking, jumping, or coughing (.54 [.45–.63]) and presence of any abdominal tenderness on examination (.49 [.19–.80]). CONCLUSIONS: Interrater reliability of patient history and physical examination variables was generally fair to moderate. Those variables with higher interrater reliability are more appropriate for inclusion in clinical prediction rules in children with possible appendicitis.

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“…[1] A cause is often not discovered during emergency department visit and in most cases a subsequent organic diagnosis is not made during outpatient follow-up. [3] Although non-specific abdominal pain is a common disorder of the young [31,32], triggers of acute pain are not known. We found that young individuals had the highest prevalence of non-specific abdominal pain and were significantly more likely to visit the emergency department for non-specific abdominal pain when indicators of air pollution were elevated.…”

Section: Discussionmentioning

confidence: 99%

“…[31,32] In both Edmonton and Montreal, women aged 15 to 24 years were more likely to visit an emergency department for non-specific abdominal pain. The reason for the disproportionate occurrence of non-specific abdominal pain in women as compared to men is not clear.…”

Section: Discussionmentioning

confidence: 99%