Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model

Trout, Andrew T.; Towbin, Alexander J.; Fierke, Shelby R.; Zhang, Bin; Larson, David B.

doi:10.1007/s00330-015-3639-x

Cited by 49 publications

(41 citation statements)

References 24 publications

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“…When different binary appendiceal diameter cut‐offs (6–9 mm) were examined, receiver operating characteristic curve evaluation revealed that 7 mm performed best in this sample with an area under the curve (AUC) of 0.886 (Figure ). Using the categorical approach proposed by Trout et al ., considering diameters below 6 mm as normal and above 8 mm consistent with appendicitis, and excluding those in between as equivocal, was more accurate than any binary cut‐off (AUC = 0.921) (Table ). Independently, blood test results were less reliable than diameter criteria, with WCC performing better (AUC = 0.751, 95% CI 0.705–0.797) than CRP (AUC = 0.700, 95% CI 0.651–0.749) (Figure ).…”

Section: Resultsmentioning

confidence: 99%

Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms

et al. 2018

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Introduction We evaluated the predictive value of sonographic and clinical variables in the diagnosis of acute appendicitis in children using decision tree modelling. Methods Data pooled from two prior studies in the same population of children referred for ultrasound examination of suspected acute appendicitis. Ultrasound and clinical variables were collated and compared with patient records. Decision tree algorithms were used to model data to identify highly discriminatory variables. Receiver operative characteristic (ROC) curve analyses were performed on different models of appendiceal diameter criteria. Results There were 687 examinations included. Diameter modelling indicated that categorical assessment – below 6 mm as negative, diameters between 6 and 8 mm equivocal for appendicitis and above 8 mm positive – was more accurate (AUROC = 0.921) than the most accurate binary cut‐off (7 mm, AUROC = 0.886). Decision tree analysis supported categorical diameter criteria, demonstrated that the presence of echogenic mesentery was an important variable and showed that common blood test results can be complementary discriminators of ultrasound findings. Discussion The use of a binary appendiceal diameter cut‐off was less accurate than a three‐category model. Absence of peri‐appendiceal mesentery inflammation is an important negative predictor of appendicitis in children, even without direct visualisation of the appendix.

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Section: Resultsmentioning

confidence: 99%

Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms

et al. 2018

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“…While the appendiceal diameter tended to be slightly higher in patients with appendicitis, the mean diameter of patients without appendicitis (6.7 +/-0.9 mm) suggests that the customary size cut-off of 6 mm is too sensitive, consistent with prior publications. A recent publication by Trout et al [23] showed improved accuracy with the use of three diagnostic categories of appendiceal cut-off diameters derived from a logistic predictive model, further casting doubt on the traditional use of a 6-mm threshold diameter.…”

Section: Discussionmentioning

confidence: 97%

Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

et al. 2016

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Loss of mural stratification, peri-appendiceal fat inflammation and an appendicolith are significant predictors of appendicitis in children with otherwise equivocal US exams. While maximum appendiceal diameter is not statistically associated with appendicitis in our study, mean appendiceal diameter of 6.7 mm in those without appendicitis suggests that the customary upper normal limit of 6 mm is too sensitive.

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“…Given this, there are some instances when an appendix measured greater than 6mm but the radiologist’s impression was not appendicitis due to lack of secondary signs or data that a larger appendiceal diameter is more accurate for diagnosing appendicitis. We recognize that there are several different appendiceal diameters that could be used as the positive test criteria for appendicitis 27,28 . We selected greater than or equal to 6mm as an abnormal appendiceal size, since this is the most traditional definition of appendicitis; however, 7mm is the typical measurement of abnormal appendix at our institution.…”

Section: 0 Discussionmentioning

confidence: 99%

Improving ultrasound for appendicitis through standardized reporting of secondary signs

Partain

Patel

Travers

et al. 2017

Journal of Pediatric Surgery

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Objective Our aim was to implement a standardized US report that included secondary signs of appendicitis (SS) to facilitate accurate diagnosis of appendicitis and decrease the use of computed tomography (CT) and admissions for observation. Methods A multidisciplinary team implemented a quality improvement (QI) intervention in the form of a standardized US report and provided stakeholders with monthly feedback. Outcomes including report compliance, CT use, and observation admissions were compared pre- and posttemplate. Results We identified 387 patients in the pre-template period and 483 patients in the posttemplate period. In the post-template period, the reporting of SS increased from 5.4% to 79.5% (p<0.001). Despite lower rates of appendix visualization (43.9% to 32.7%, p<0.001) with US, overall CT use (8.5% vs 7.0%, p=0.41) and the negative appendectomy rate remained stable (1.0% vs 1.0%, p=1.0). CT utilization for patients with an equivocal ultrasound and SS present decreased (36.4% vs 8.9%, p=0.002) and admissions for observations decreased (21.5% vs 15.3%, p=0.02). Test characteristics of RLQ US for appendicitis also improved in the posttemplate period. Conclusion A focused QI initiative led to high compliance rates of utilizing the standardized US report and resulted in lower CT use and fewer admissions for observation.

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Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model

Cited by 49 publications

References 24 publications

Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms

Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms

Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

Improving ultrasound for appendicitis through standardized reporting of secondary signs

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