Acute appendicitis in childhood: oral contrast does not improve CT diagnosis

Farrell, Crystal R; Bezinque, Adam; Tucker, Jared M.; Michiels, Erica A.; Betz, Bradford W.

doi:10.1007/s10140-017-1574-7

Cited by 18 publications

(9 citation statements)

References 31 publications

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“…Our experience has shown no significant difference in the identification of the appendix between the two groups (P = 1), consistent with the literature in children not stratified by weight. 7 Although there was no significant difference in identifying the appendix with or without oral contrast, the inter-rater reliability in identifying the appendix was significantly higher in the group receiving oral contrast material. There was almost perfect agreement between the 2 raters in identifying the appendix with oral contrast, compared to fair agreement without the oral contrast.…”

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

“…Farrell et al have shown that oral contrast did not improve diagnostic accuracy of acute appendicitis in pediatric patients; 7 however, the cohorts were not stratified by weight or body BMI. A study conducted by Garcia et al assessing the adequacy of intra-abdominal fat when identifying the appendix with intravenous (IV) contrast-enhanced CT without oral contrast, demonstrated a strong relationship between intra-abdominal fat and patient weight and age.…”

Section: Introductionmentioning

confidence: 97%

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Is Oral Contrast Beneficial for Visualization of the Appendix in Low-Weight Children?

et al. 2022

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Purpose: It has been shown that oral contrast does not improve the diagnostic accuracy of Computed Tomography (CT) for appendicitis in pediatric patients; however, the cohorts in these studies were not stratified by weight or body mass index. The purpose of this study is to assess the benefit of oral contrast administration for identifying the appendix in younger children in the lower weight quartile. Materials and Methods: This retrospective study comprised 100 patients (2–10 years) in lower weight quartile who had intravenous contrast-enhanced CT of the abdomen and pelvis, 37 of which with oral contrast, and 63 without. A pediatric radiologist and a pediatric radiology fellow independently assessed whether the appendix was visualized or not. In case of discrepancy, an additional pediatric radiologist was the “tie-breaker.” Chi-squared test was used to compare the proportion of visualized appendix between the groups (with and without oral contrast). Inter-rater reliability was determined using Cohen’s Kappa coefficient. Results: There was no significant difference in the visualization of the appendix between the group with oral contrast and without ( P = 1). The Cohen Kappa coefficients were .33 (.05, .62) and .91 (.73, 1.00) for the “no oral” and “oral” groups, respectively, yielding evidence of a difference ( P = .007). Conclusions: There was no significant difference in the visualization of the appendix using CT with or without oral contrast in low-weight pediatric patients. The inter-rater reliability, however, was significantly higher in the group given oral contrast. Additional studies assessing the value of oral contrast for the sole indication of appendicitis may provide clearer results.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Is Oral Contrast Beneficial for Visualization of the Appendix in Low-Weight Children?

et al. 2022

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“…44 Publications were also identified from Australia, 45,46 China, 47,48 the European Union, 49 France, 50,51 India, 52 Ireland, 53 Israel, 54,55 the Netherlands, 56 New Zealand, [57][58][59][60] Norway, 61 Saudi Arabia, 62 Singapore, 63 South Korea, 64 Sweden, 65 Taiwan, 66 the UK, 67-81 and the US. [82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] The following section is a high-level summary of some of the commonly reported themes and strategies from the included publications. Additional details regarding the included publications are available in Appendix 1 on frameworks (Table 2), Canadian implementation plans and recommendations (Table 3), international implementation plans and recommendations (Table 4), and strategies to address wait times (Table 5).…”

Section: Resultsmentioning

confidence: 99%

“…• door-to-scan time (eg, providing patients with information before their appointment, streamlined or rapid pathways [e.g., not requiring contrast agent, patients who meet defined criteria do not require a full prescan review]) 14,15,29,32,51,74,77,78,82,92,93 • time spent in scanner (eg, remove unnecessary sequences, optimize parameters, rapid acquisition protocols) 8,14,72,83,90,91,94 • processing time (eg, new algorithms that speed up processing of scan images) 88 General strategies to improve efficiency may include:…”

Section: Type Of Strategy Examplesmentioning

confidence: 99%

Wait List Strategies for CT and MRI Scans

CADTH¹

2023

cjht

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There are various potential causes of long wait times for CT and MRI scans, and conducting a situation-specific assessment of available resources and potential cause(s) of wait times may help to identify appropriate strategies for their management. Identified principles for developing a plan to address wait times include engaging stakeholders, taking a coordinated approach to develop short- and long-term plans, ensuring plans are flexible to account for changes in technologies, and developing a plan for quality monitoring and assessment of specified outcomes. Identified strategies for reducing wait times for CT and/or MRI scans include increasing capacity, improving efficiencies, reducing low-value scans, improving communication, and adopting new technology.

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Imaging of pediatric ovarian tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

Behr

Morani

Artunduaga

et al. 2022

Pediatric Blood & Cancer

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Ovarian tumors in children are uncommon. Like those arising in the adult population, they may be broadly divided into germ cell, sex cord, and surface epithelium subtypes; however, germ cell tumors comprise the majority of lesions in children, whereas tumors of surface epithelial origin predominate in adults. Diagnostic workup, including the use of imaging, requires an approach that often differs from that required in an adult. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary ovarian malignancy at diagnosis and during follow‐up.

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Acute appendicitis in childhood: oral contrast does not improve CT diagnosis

Abstract: For children evaluated by CT with IV contrast for suspected appendicitis, administering oral contrast increased wait time by > 90 min, did not reach the cecum in 48% of cases, and did not improve diagnostic accuracy. Oral contrast for pediatric CT appendicitis evaluation is not warranted.

Cited by 18 publications

References 31 publications

Is Oral Contrast Beneficial for Visualization of the Appendix in Low-Weight Children?

Is Oral Contrast Beneficial for Visualization of the Appendix in Low-Weight Children?

Wait List Strategies for CT and MRI Scans

Imaging of pediatric ovarian tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

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