Ultrasonography for diagnosis of acute appendicitis

Wild, Jonathan; Abdul, Nicole; Ritchie, Judith; Rud, Bo; Freels, Sally; Nelson, Richard L.

doi:10.1002/14651858.cd010402

Cited by 6 publications

(2 citation statements)

References 50 publications

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“…Over the past decade, there has been more attention given to the risks of radiation exposure in the pediatric population. Despite publication of evidencebased reviews and Cochrane recommendations for increased use of US, the surgeons in our community hospital were continuing to see a large number of CT scans ordered on pediatric patients with abdominal pain, usually before consulting with them [15]. This concern led to the implementation of the Pediatric Appendicitis Score in our institution and this retrospective study was used to evaluate our own outcomes with this change in practice.…”

Section: Discussionmentioning

confidence: 99%

The use of a score-based protocol in pediatric appendicitis decreases CT scan utilization when evaluating children in a community hospital

Hulka

Morris

Elliott³

et al. 2021

Ann Pediatr Surg

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Background The Pediatric Appendicitis Score (PAS) is a validated scoring system assessing children with abdominal pain. Prior to 2016, children with abdominal pain in our community hospital were evaluated primarily using CT scans. A protocol using PAS and ultrasound (US) as the primary radiologic modality was adopted in 2016 for evaluating children with abdominal pain. The protocol consisted of three tiers with low PAS requiring no radiologic evaluation; moderate PAS requiring US and high PAS requiring initial surgical consultation. Retrospective chart review of children presenting with clinically suspected appendicitis was performed from January 2015 through December 2017, representing 1 year before and 2 years after implementation of PAS protocol. PAS scoring was assigned retrospectively to patients not scored in the emergency physician’s note, and statistical analysis of the patient cohorts was performed using SPSS, version 17. This study was approved by the University of Nevada Institutional Review Board. Results Application of PAS scoring system increased use of US as the primary radiologic test from 59% pre-protocol to 91% post protocol and decreased use of CT scans from 41 to 8% (p < .05). Physician adherence to protocol improved from 59 to 71%, increasing further to 81% in the 2nd year post-protocol (p < .05). The highest rate of non-compliance was noted when providers ordered an US in patients with a low PAS, followed by ordering any radiologic tests in patients with a high PAS. Conclusion Implementation of PAS-based protocol altered clinician behavior in a community hospital when evaluating children with clinically suspected appendicitis. Improved adherence to the protocol over time with significant decrease of CT scans ordered thereby reducing radiation exposure in the pediatric population. Future improvements will be aimed at decreasing radiologic testing in patients with a low PAS and involving surgeons earlier with patients who have a high PAS as clinical acceptance to the protocol matures.

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Section: Discussionmentioning

confidence: 99%

The use of a score-based protocol in pediatric appendicitis decreases CT scan utilization when evaluating children in a community hospital

Hulka

Morris

Elliott³

et al. 2021

Ann Pediatr Surg

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“…Recent studies advocate the use of medical imaging to reduce the rate of negative appendectomies [ 7 ]. Among available imaging modalities such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), US may be especially useful where there are equivocal clinical signs or an indeterminate diagnostic score.…”

Section: Introductionmentioning

confidence: 99%

Automatic Extraction of Appendix from Ultrasonography with Self-Organizing Map and Shape-Brightness Pattern Learning

Kim

Song

Park

2016

BioMed Research International

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Accurate diagnosis of acute appendicitis is a difficult problem in practice especially when the patient is too young or women in pregnancy. In this paper, we propose a fully automatic appendix extractor from ultrasonography by applying a series of image processing algorithms and an unsupervised neural learning algorithm, self-organizing map. From the suggestions of clinical practitioners, we define four shape patterns of appendix and self-organizing map learns those patterns in pixel clustering phase. In the experiment designed to test the performance for those four frequently found shape patterns, our method is successful in 3 types (1 failure out of 45 cases) but leaves a question for one shape pattern (80% correct).

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