Benchmarking the value of ultrasound for acute appendicitis in children

Cundy, Thomas P.; Gent, Roger; Frauenfelder, Claire; Lukic, Laura; Linke, Rebecca; Goh, Day Way

doi:10.1016/j.jpedsurg.2016.09.009

Cited by 43 publications

(32 citation statements)

References 29 publications

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“…While some studies have demonstrated that the appendix can almost invariably be found in children with ultrasound, many centres are only able to achieve visualisation rates of around 50% or lower . Improved visualisation can result by providing training in appendix ultrasound techniques to sonographers performing these studies .…”

Section: Introductionmentioning

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: Introductionmentioning

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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“…Test characteristics of ultrasounds that visualize the appendix were estimated from published studies that excluded nonvisualized appendices. 8,9,16-18, [24][25][26][27][30][31][32][33] Test characteristics of the presence of secondary signs of inflammation in ultrasounds that do not visualize the appendix were estimated from studies that separately reported the test characteristics when the appendix is not visualized, with and without secondary signs,9,16,24,27,30-32 assuming that patients with secondary signs had appendicitis and those without secondary signs did not have appendicitis. We used a weighted average from these studies for sensitivity and specificity point estimates.…”

Section: Model Input Datamentioning

confidence: 99%

“…We estimated visualization rates for patients with and without appendicitis separately using weighted averages from published data. 8,9,16,18, [24][25][26][27][30][31][32][33] None of the appendix visualization studies differentiated between ruptured and nonruptured appendices.…”

Section: Model Input Datamentioning

confidence: 99%

“…All but 3 strategies were dominated, with lower effectiveness and higher cost than their next least expensive comparators being observed ( Table 2, Supplemental Table 4). Strategies B Proportion of patients with appendicitis 8-10,14-16,24-29 0.326 0.145-0.614 Ultrasound with visualized appendix, sensitivity 8,9,16-18, [24][25][26][30][31][32][33] 0.986 0.957-1.0 Ultrasound with visualized appendix, specificity 8,9,16-18, [24][25][26][30][31][32][33] 0.936 0.654-1.0 Proportion ultrasound that do not visualize appendix among patients with appendicitis 8,9,16,18, [24][25][26][27][30][31][32][33] 0.158 0.0172-0.394 Proportion ultrasound that do not visualize appendix among patients without appendicitis 8,9,16,18, [24][25][26][27][30][31][32][33] 0.466 0.104-0.910 Secondary signs of inflammation on ultrasound without visualized appendix, sensitivity 9,16, 24,27,[30][31][32]34 0.534 0.29-1.0 Secondary signs of inflammation ultrasound without visualized appendix, specificity 9,16, 24,27,[30][31][32] 0.9439 0.6-0.99 CT, sensitivity…”

Section: Cost-effectivenessmentioning

confidence: 99%

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Cost-effectiveness of Imaging Protocols for Suspected Appendicitis

Jennings¹,

Guo

Goldin

et al. 2020

Pediatrics

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BACKGROUND: Inaccurate diagnosis of appendicitis leads to increased costs and morbidity. Ultrasound costs less than computed tomography (CT) or MRI but has lower sensitivity and may not visualize the appendix. METHODS: We conducted a cost-effectiveness analysis using a decision-analytic model of 10 imaging strategies for suspected appendicitis in a hypothetical cohort of patients: no imaging with discharge or surgery; CT only; MRI only; or staged approach with CT or MRI after 1) negative ultrasound result or ultrasound without appendix visualization, 2) ultrasound without appendix visualization, or 3) ultrasound without appendix visualization but with secondary signs of inflammation. Inputs were derived from published literature and secondary data (quality-of-life and cost data). Sensitivity analyses varied risk of appendicitis and proportion of visualized ultrasound. Outcomes were effectiveness (quality-adjusted lifeyears [QALYs]), total direct medical costs, and cost-effectiveness (cost per QALY gained). RESULTS: The most cost-effective strategy for patients at moderate risk for appendicitis is initial ultrasound, followed by CT if the appendix is not visualized but secondary signs are present (cost of $4815.03; effectiveness of 0.99694 QALYs). Other strategies were well above standard willingness-to-pay thresholds or were more costly and less effective. Cost-effectiveness was sensitive to patients' risk of appendicitis but not the proportion of visualized appendices. CONCLUSIONS: Tailored approaches to imaging based on patients' risk of appendicitis are the most cost-effective. Imaging is not cost-effective in patients with a probability ,16% or .95%. For moderate-risk patients, ultrasound without secondary signs of inflammation is sufficient even without appendix visualization.

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“…In this case, diagnostic imaging in the form of abdominal ultrasound was able to ascertain a diagnosis of appendicitis preoperatively. Abdominal ultrasound in children has a diagnostic accuracy of 95.5% for acute appendicitis, with sensitivity and specificity of 97.1% and 94.8%, respectively 7…”

Section: Differential Diagnosismentioning

confidence: 99%

Simultaneous acute appendicitis in identical twin boys

Kovler¹,

Jelin

2019

BMJ Case Rep

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Acute appendicitis is one of the most common causes of abdominal pain in children but remains a diagnostic challenge, and insight into the aetiology of the condition is lacking. A case of simultaneous acute appendicitis in monozygotic twin boys is reported here. Familial aggregation in acute appendicitis has been described, but the underlying causes for this are not well understood. The patients reported here were both genetically identical and lived a mostly identical lifestyle. Their simultaneous presentation would be exceedingly rare if explained entirely by chance, suggesting a role for both genetic and environmental influences. Increased knowledge of this occurrence may assist in prompt diagnosis and reporting on the incidence and timing of appendicitis in monozygotic twins could better elucidate the genetic and environmental factors that predispose to this disease.

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Benchmarking the value of ultrasound for acute appendicitis in children

Cited by 43 publications

References 29 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

Cost-effectiveness of Imaging Protocols for Suspected Appendicitis

Simultaneous acute appendicitis in identical twin boys

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