Appendicitis: usefulness of US in diagnosis in a pediatric population.

Sivit, Carlos J.; Newman, Kurt D.; Boenning, Douglas A.; Nussbaum-Blask, Anna; Bulas, Dorothy; Bond, Simon; Attorri, R; Rebolo, L C; Brown-Jones, C; Garin, D B

doi:10.1148/radiology.185.2.1410371

Cited by 161 publications

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“…Likewise, the range of overall accuracy has been reported to be 59%-98%, but narrows to 89%-98% when only pediatric studies are examined (Table 3). 9,[23][24][25][26][27][28] A 2004 study reported a sensitivity of 100%, a specificity of 93% and an overall accuracy of 98% using contrast-enhanced Doppler ultrasound. 45 Another study evaluated operator-dependant techniques in 877 patients (age range 2-85 yr) with abdominal ultrasound to which they applied 4 additional manoeuvres to the standard examination.…”

Section: Ultrasoundmentioning

confidence: 99%

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Brennan

2006

CJEM

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Evaluating children for appendicitis can be extremely difficult, and various strategies have been developed to improve the precision of preoperative diagnosis. Among these, ultrasound and computed tomography (CT) are now widely used but remain controversial. Although CT scanning is superior to ultrasound in terms of diagnostic accuracy for appendicitis, the large dose of ionizing radiation from CT and the risk of subsequent radiation-induced malignancy (RIM) are of particular concern in pediatric patients. This article reviews the literature on the pathophysiology, morbidity and mortality of appendicitis, summarizes the data regarding pediatric imaging in appendicitis, provides a practical approach to imaging for clinicians who evaluate pediatric patients, and makes recommendations for reducing the risk of RIM in pediatric patients. RÉSUMÉIl peut être extrêmement difficile d'évaluer les enfants pour diagnostiquer l'appendicite et diverses stratégies ont été mise au point pour améliorer la précision du diagnostic préopératoire. L'échographie et la tomodensitométrie (TDM), notamment, sont maintenant très répandues, mais elles demeurent controversées. Même si la TDM est supérieure à l'échographie pour ce qui est de l'exactitude du diagnostic d'appendicite, une dose importante de rayonnements ionisants provenant de l'appareil et le risque de tumeur maligne radio-induite (TMRI) subséquente préoc-cupe particulièrement chez les patients en pédiatrie. Dans cet article, les auteurs passent en revue les publications sur la pathophysiologie, la morbidité et la mortalité de l'appendicite, résument les données sur l'imagerie pédiatrique dans les cas d'appendicite, présentent une stratégie pratique d'imagerie pour les cliniciens qui évaluent des patients en pédiatrie et formulent des recommandations afin de réduire le risque de TMRI chez les patients en pédiatrie.

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Section: Ultrasoundmentioning

confidence: 99%

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Brennan

2006

CJEM

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“…Si bien es cierto que el ultrasonido y la tomografía computadorizada se han revelado como métodos de diagnóstico de muy alta confiabilidad en los diag nósticos de apendicitis aguda, las limitaciones tec nológicas de los servicios de valoración inmediata, llevan a replantear cuándo está indicado realizar una exploración radiológica ante la sospecha de apen dicitis aguda. A pesar de que no se han adelantado muchos estudios al respecto, predomina la idea de que las téc-nicas de imagen deben servir de apoyo al diagnóstico clínico exclusivamente en el caso de que éste sea dudoso (15,16) . Otros autores consideran, sin embargo, que el uso de las técnicas de imagen podría facilitar el manejo, inclusive de los pacientes con diagnósticos clínicos de apendicitis aguda.…”

Section: Discussionunclassified

Utility of Alvarado´s Score in Acute Appendicitis at Hospital De Clinicas - Paraguay

2017

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RESUMENObjetivo. Evaluar las puntuaciones de la escala de Alvarado en una serie de casos intervenidos quirúrgicamente con diagnóstico de apendicitis aguda.Materiales y métodos. Estudio descriptivo de corte transversal. Se revisaron historias de 159 pacientes sometidos a cirugía con diagnóstico de apendicitis aguda, de enero a junio de 2015. Se estimó la puntuación alcanzada en la escala de Alvarado y se correlacionó con el resultado histopatológico, tiempo de evolución, sexo y edad.Resultados. El 56,6 % correspondió a hombres y el promedio de edad de 38,4 años. El tiempo de evolución registró un promedio de 36 horas para las mujeres y 40,75 horas para los hombres. En el 94% de los casos presentaban dolor en fosa ilíaca derecha, 48% fiebre graduada, 77% náuseas o vómitos, 96% signo de Blumberg positivo, 81% anorexia, 77% migración del dolor, 78,8% leucocitosis, 88,4% neutrofilia. La media registrada con la escala de Alvarado fue de 8; 7,89 en mujeres y 7,91 en hombres. Hubo concordancia diagnóstica del 98% entre la escala de Alvarado y resultado histopatológico.Conclusión. La escala de Alvarado puede ser una herramienta útil para mejorar la eficiencia diagnóstica en la apendicitis aguda, sobre todo en los servicios de atención ambulatoria y urgencias.Palabras Claves: Apendicitis aguda, Escala diagnóstica de Alvarado, Abdomen agudo quirúrgico. SUMMARY Objective:Evaluate the scale scores of Alvarado in a series of cases operated on with diagnosis of acute appendicitis.Materials and methods. A descriptive cross-sectional study. 159 stories were reviewed of patients undergoing surgery with a diagnosis of acute appendicitis, from January to June 2015. It was felt the score attained in the scale of Alvarado and correlated with the histopathological result, time of evolution, sex and age.Results. The 56.6 % were men and the average age of 38.4 years. The time of evolution, an average of 36 hours for 40.75 hours for women and men. In 94% of cases presented pain in the right iliac fossa, 48% 77% graduate fever, nausea or vomiting, 96% positive sign of Blumberg, 81% anorexia, 77% migration of pain, 78.8% leukocytosis, 88.4% neutrophilia. The average recorded with the scale of Alvarado was of 8; 7.91 7.89 in women and in men. There were 98% of the diagnostic concordance between the scale of Alvarado and histopathological result.Conclusion. The scale of Alvarado can be a useful tool to improve diagnostic efficiency in acute appendicitis, especially in ambulatory care services and emergency services.Keywords: Acute appendicitis, Scale of Alvarado, Acute surgical abdomen. INTRODUCCIÓN La primera apendicectomía reportada se practicó en 1735(1), y la descripción histopatológica de la inflamación del apéndice y posterior evolución hacia peritonitis fue publicada por R. H. Fitz, en 1886 (2). En la actualidad, se reconoce que la apendicitis aguda afecta a 7 % de cual quier población, sin ajustar por sexo, aunque se reporta mayor frecuencia en los hombres, lo que hace de ella la urgencia quirúrgica abdominal más frecuente en las ins...

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“…The challenge is that it is difficult to obtain a clear history in children as not all patients present classical symptoms and many disorders of the gastrointestinal tract mimic acute appendicitis [4] . Acute appendicitis remains a clinical diagnosis but when the diagnosis of acute appendicitis is difficult, abdominal ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis [5,6] .…”

Section: Introductionmentioning

confidence: 99%

Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

Fakhry

Shawky

2017

J Pediatr Dis

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Appendicitis is the most common cause of emergency abdominal surgeries in children. Ultrasound (US) has been proven to be a helpful imaging modality in patient evaluation, especially in children suspected of appendicitis. The Alvarado score is a 10-point scoring system for the diagnosis of appendicitis based on clinical data and differential leukocyte count. The aim of the present study was to evaluate a combination of clinical scoring (Alvarado score) and US findings for accurate diagnosis of appendicitis in children. The study was done in Menoufia University Hospitals from March 2011 to January 2013. 322 children with abdominal pain clinically suspected of having appendicitis were included in the study and clinically assessed to calculate the Alvarado score. Patients were referred to the radiology department for abdominal US. Among the 153 of the 322 patients who were operated on, 149 patients were diagnosed pre-operatively with acute appendicitis and 4 girls were diagnosed with complex ovarian cysts. Of the 149 patients diagnosed with appendicitis, the percentage of appendicitis was 93% (139/149) and 10 (7%) patients had normal appendix. The prevalence of appendicitis among the patients of the study was 43% (139/322). In conclusion, a combination of Alvarado scores and abdominal US is a good approach for the diagnosis of appendicitis in children to reduce the number of laparotomies for normal appendix. In the case of normal appendix or nonvisualization of the appendix via abdominal US without a high Alvarado score, appendicitis can be safely ruled out. If it is proven as an inflamed appendix on US or a high Alvarado score, patient should be subjected for appendectomy without delay. Keywords

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Appendicitis: usefulness of US in diagnosis in a pediatric population.

Cited by 161 publications

References 0 publications

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Utility of Alvarado´s Score in Acute Appendicitis at Hospital De Clinicas - Paraguay

Combination of Alvarado score and ultrasound findings in diagnosis of acute appendicitis in children

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