When does ultrasonography influence management in suspected appendicitis?

Scrimgeour, Duncan; Driver, Chris; Stoner, Rebecca; King, Sebastian K.; Beasley, Spencer W.

doi:10.1111/ans.12415

Cited by 11 publications

(14 citation statements)

References 11 publications

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“…Nonvisualization of the appendix, in the absence of RLQ tenderness and inflammatory change, makes major pathology highly unlikely. 5 The NPV of reported NVA in the absence of secondary signs of appendicitis in this study was 98.3%. Given the high NPV of US, active clinical observation and patient education may be options that do not increase negative outcomes.…”

Section: Discussionmentioning

confidence: 49%

“…3,4 With the continued improvement in the quality of ultrasound (US) resolution and technology, visualization of the normal appendix is now a frequently reported finding by radiologists in their assessment of RLQ pain. 5 As a corollary, nonvisualization of the appendix (NVA) is also now routinely reported by some radiologists, even though its visualization is not a criterion to exclude appendicitis. 6 We believe that reporting NVA may falsely imply that an incomplete study has been performed and appendicitis cannot be ruled out.…”

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confidence: 99%

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When the Appendix Is Not Seen on Ultrasound for Right Lower Quadrant Pain

Ly¹,

Khalili²,

Gray³

et al. 2016

Ultrasound Quarterly

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A survey was administered to 166 academic emergency department (ED) physicians to determine their interpretation and practice after receiving an ultrasound (US) report with nonvisualization of the appendix (NVA). Annual incidence of reported NVA from 2 academic hospitals was calculated for 2002-2013. A retrospective review of the same hospitals revealed that 291 (17.4%) of 1672 USs performed for appendicitis in 2012 indicated NVA. These cases underwent a chart review to determine the negative predictive value of reported NVA and utility of secondary findings. Univariate analysis was performed to determine significant predictors of secondary signs of appendicitis on computed tomography. Ninety eight (59%) of 166 ED physicians completed the survey. Forty nine (52%) of 94 respondents agreed that in the setting of reported NVA with no other acute findings, appendicitis has not been excluded and requires further imaging. There was a significant rise in the incidence rate of reported NVA for appendicitis, 22.5% (2002) up to 41.2% (2013, P < 0.0001). Negative predictive value for reported NVA was 216 (94.3%) of 229; in 9 (69%) of 13 patients, secondary signs of appendicitis were noted. Inflammatory changes in right lower quadrant (P = 0.01) and focal tenderness (P = 0.02) noted on US were significant predictors of a positive computed tomography scan. Current perceptions and practice of some ED physicians equate NVA on US as an inadequate study to exclude appendicitis. However, reported NVA is itself a highly predictive sign (94.3%) of absence of appendicitis even when an alternate cause of pain is not seen.

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Section: Discussionmentioning

confidence: 49%

mentioning

confidence: 99%

When the Appendix Is Not Seen on Ultrasound for Right Lower Quadrant Pain

Ly¹,

Khalili²,

Gray³

et al. 2016

Ultrasound Quarterly

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“…Despite a higher negative appendectomy rate in girls [2–5], imaging is frequently more used in this group [6–8]. Perforated appendicitis and negative appendectomy have a reported frequency of 17–35% [4, 9–11] and 1–12%, respectively [4, 7, 8, 10]. When introducing preoperative imaging for suspected appendicitis in children, there were hopes for a reduction of perforations and negative appendectomies; nevertheless the literature is showing inconsistent results [5, 7].…”

Section: Introductionmentioning

confidence: 99%

“…Another factor is the operator dependency of US. An equivocal result, when appendix is partly or not visualized, is not uncommon while using US [8, 12, 13, 16, 17]. The operator-dependent nature of US can possibly explain some of the discrepancy in sensitivity between US and CT [18].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound for Appendicitis: Performance and Integration with Clinical Parameters

Löfvenberg

Salö

2016

BioMed Research International

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Objective. To evaluate the performance of ultrasound in pediatric appendicitis and the integration of US with the pediatric appendicitis score (PAS) and C-reactive protein (CRP). Method. An institution-based, retrospective study of children who underwent abdominal US for suspected appendicitis between 2012 and 2015 at a tertiary pediatric surgery center. US results were dichotomized, with a nonvisualized appendix considered as a negative examination. Results. In total, 438 children were included (mean 8.5 years, 54% boys), with an appendicitis rate of 29%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US were 82%, 97%, 92%, and 93%, respectively, without significant age or gender differences. Pediatric radiologists had significantly higher sensitivity compared to general radiologists, 88% and 71%, respectively (p < 0.01), but no differences were seen for specificity, PPV, and NPV. The sensitivity, NPV, and negative likelihood ratio for the combination of negative US, PAS < 5, and CRP < 5 mg/L were 98%, 98%, and 0.05 (95% CI 0.03–0.15). Conclusion. US may be a useful tool for evaluating children with suspected appendicitis, regardless of age or gender, and should be the first choice of imaging modalities. Combining US with PAS and CRP may reduce several unnecessary admissions for in-hospital observation.

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“…In this issue of ANZ Journal of Surgery , Scrimgeour et al . question the value and influence of US in childhood appendicitis.…”

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confidence: 99%