Pediatric appendiceal ultrasound: maintaining accuracy, increasing determinacy and improving clinical outcomes following the introduction of a standardized reporting template

Unsdorfer, Kyle M. L.; An, Julie Y.; Binkovitz, Larry A.

doi:10.1007/s00247-020-04820-z

Cited by 17 publications

(11 citation statements)

References 15 publications

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“…Nevertheless, the sample of non-visualized cases is small and the study is likely underpowered to make these conclusions. Structured US evaluation for appendicitis and associated secondary sonographic findings as well as standardized reporting of these findings have previously led to improved visualization rates and less utilization of additional cross sectional imaging [13][14][15]. Our study had a visualization rate that was relatively high as compared to rates reported in the literature [1,4].…”

Section: Discussionmentioning

confidence: 63%

“…Similarly, the absence of these secondary sonographic findings may be sufficient to exclude the diagnosis of appendicitis [10][11][12]. Structured ultrasound (US) evaluation for secondary findings, in combination with sonographer training aimed at searching for these findings, has been shown to provide more meaningful US interpretations [13], and standardized reporting has been shown to decrease reliance on computed tomography (CT) as well as admissions for observation [14,15]. When the appendix is visualized on US, but appendicitis cannot be confirmed, this may lead to additional cross-sectional imaging, transfer to centers with available pediatric surgeons, or hospitalization for clinical monitoring.…”

Section: Introductionmentioning

confidence: 99%

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Does age affect the test performance of secondary sonographic findings for pediatric appendicitis?

et al. 2021

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Background Secondary sonographic findings of appendicitis can aid image analysis and support diagnosis with and without visualization of an appendix. Objective We sought to determine if age affected the test performance of secondary findings for pediatric appendicitis. Materials and methods We performed a medical record review of emergency department patients younger than 19 years of age who had a sonogram for suspected appendicitis. Our primary patient outcome was appendicitis, as determined by pathology or by image-confirmed perforation/abscess. Our primary analysis was test performance of secondary sonographic findings as recorded by sonographers on the final diagnosis of appendicitis stratified by age (<6 years, 6 to <11 years, 11 to <19 years). Results A total of 1,219 patients with suspected appendicitis were evaluated by ultrasound, and 1,147 patients met the criteria for analysis. Of the 1,147 patients, 431 (37.6%) had a final diagnosis of appendicitis. Across all age groups, echogenic fat was the most accurate secondary finding (92.5% [95% confidence interval (CI): 91.0, 94.0]) and free fluid was the least accurate secondary finding (54.7% [95% CI: 51.8, 57.5]). There was no significant difference in the age-stratified test performance of secondary sonographic findings except that (1) appendicolith was a more accurate predictor in patients <6 years old than in the middle group (P<0.001) or the oldest group (P<0.001), and (2) free fluid was a more accurate predictor in the middle group than in the oldest group (P=0.02). Conclusion There are no significant differences in the age-stratified test performance of secondary sonographic findings in the prediction of pediatric appendicitis except that appendicolith is more predictive in younger patients.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Does age affect the test performance of secondary sonographic findings for pediatric appendicitis?

et al. 2021

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“…Although the literature regarding the proportion of appendiceal visualization in NSAP and PAA groups is scarce, in our clinical experience it is more likely that non-visualization corresponds to NSAP cases (with a smaller appendicular caliber), since in PAA cases the appendix is usually enlarged and presents locoregional inflammatory changes that facilitate its identification. However, it is worth mentioning that recent working groups, through the implementation of specific reporting templates and education sessions, have managed to improve ultrasonographic appendix identification [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children

et al. 2023

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Background Pediatric acute appendicitis (PAA) continues to be a diagnostic challenge today. The diagnostic performance of classical indices is only moderate, especially in pediatric population. This study aimed to define a clinical, radiological and analytical index for the diagnosis of PAA. Materials and methods This prospective study included 151 patients divided into two groups: (1) 53 patients with non-surgical abdominal pain (NSAP) and (2) 98 patients with a confirmed PAA. Sociodemographic and clinical characteristics were compared between groups using the Mann–Whitney U test and the Fisher exact test. To identify the predictors of PAA, we performed a multivariable logistic regression using a forward stepwise analysis and we assigned multiples of integer values to the selected variables. The diagnostic performance of the index was assessed by calculating the area under the receiver operating characteristic curve. Intra-cohort calibration was assessed with the Hosmer–Lemeshow test. Results We developed the BIDIAP index (BIomarkers for the DIagnosis of Appendicitis in Pediatrics), which included three variables that independently predicted higher odds of PAA: appendiceal caliber (≥ 6.9 mm), systemic immune-inflammation index (≥ 890) and peritoneal irritation, which scored 4, 3 and 2 points, respectively. Mean (SD) score of the participants was 2.38 (2.06) in group 1 and 7.89 (1.50) in group 2. The area under the ROC was 0.97 (95% CI 0.95–0.99). The cut-off point was established at 4 points, resulting in a sensitivity of 98.98% and a specificity of 77.78%. Conclusions The BIDIAP index has an exceptional diagnostic performance in PAA. The importance of these results lies in its novelty and in the simplicity of the index. Although external validation will be necessary, initial results look promising.

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“…Previous studies have shown that hospitals with more pediatric patients or a pediatric-focused ED had signi cantly lower CT scan rates for abdominal pain [28,29] because of better accessibility and more experience, which emphasizes the importance of proper training. Also, standardization of radiology reporting, such as a structured report template, can be considered [30,31] for better communication between radiologists and treating physicians. At the same time, it is important for treating physicians to provide radiologists with accurate clinical information.…”

Section: Discussionmentioning

confidence: 99%

Factors affecting uncertain radiologic reports for pediatric abdominal ultrasound in pediatric emergency departments

Hwang

Chung

Park

et al. 2022

Preprint

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Backgrounds Abdominal pain is a common cause for children presenting to pediatric emergency department (PED), which often requires ultrasound (US). However, uncertain reports can lead to additional imaging, which Objective In this study, we evaluated the factors affecting uncertain reports in pediatric abdominal ultrasound in the PED. Materials and Methods This is a retrospective cohort study. Children younger than 18 years at the study hospital between January 2017 and December 2019 who underwent an abdominal US in the PED were eligible. After exclusion, researchers manually reviewed every US report and classified. To identify factors that lead to an uncertain report, univariate and multivariate logistic regression was performed. Results A total of 1006 patients was included in the final analysis. After review, 796 patients were tagged as certain reports, and 210 were tagged as uncertain reports. Children with uncertain reports were more likely to have undergone an additional CT scan (31.0% vs. 2.5%, p <0.001), and had a longer PED length of stay (321 minutes vs. 284.5 minutes, p =0.042). After logistic regression, US performed by a radiology resident (odds ratio [OR] 5.01, 95% confidence interval [CI] 3.63-7.15) was the most significant factor. Conclusion Several factors are responsible for uncertain radiologic reports of abdominal US in the pediatric population. Uncertain radiologic reports increase the likelihood of additional CT scans. Measures to improve the clarity of radiologic reports must be considered to improve the quality of care in children visiting the PED.

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Pediatric appendiceal ultrasound: maintaining accuracy, increasing determinacy and improving clinical outcomes following the introduction of a standardized reporting template

Cited by 17 publications

References 15 publications

Does age affect the test performance of secondary sonographic findings for pediatric appendicitis?

Does age affect the test performance of secondary sonographic findings for pediatric appendicitis?

The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children

Factors affecting uncertain radiologic reports for pediatric abdominal ultrasound in pediatric emergency departments

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