Clinical Outcomes of Pediatric Patients With Acute Abdominal Pain and Incidental Findings of Free Intraperitoneal Fluid on Diagnostic Imaging

Matz, Samantha; Connell, Mary J.; Sinha, Madhumita; Goettl, C.; Patel, Palak C.; Drachman, David A.

doi:10.7863/ultra.32.9.1547

Cited by 10 publications

(16 citation statements)

References 7 publications

(12 reference statements)

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“…The majority of patients with normal USG or findings suggestive of a non-surgical or infectious condition did not have FF while FF was common in patients with a gynecologic or urologic condition. Similarly, in the study by Matz et al, the final diagnosis was of gynecologic or urologic origin in 36% of patients who had intra-abdominal FF alone [19].…”

Section: Discussionmentioning

confidence: 98%

“…The hospitalization rate was 74.1% for patients with both FF and pathological conditions while it was 17.6% for patients with FF alone. Matz et al found a discharge rate of 48.8% for patients with FF but without a confirmed surgical pathology [19]. Also, the presence of FF alone did not affect re-admission to another health care facility (p=0.99).…”

Section: Discussionmentioning

confidence: 99%

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Significance of Intra-abdominal Free Fluid Detected in Ultrasonography in the Clinical Assessment and Outcomes of Adult Patients Presenting to the Emergency Department Due to Abdominal Pain

Erkek¹,

Aydın²,

Çiftçi³

et al. 2019

Cureus

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ObjectiveThe aim of the study was to evaluate the diagnostic process and clinical course in adult patients who presented to the emergency department (ED) with acute abdominal pain (AAP) and were found to have intra-abdominal free fluid (FF) on ultrasonography (USG).MethodsThis prospective observational study was conducted in a training and research hospital adult emergency department between March 15, 2013, and April 15, 2013. The study included 252 patients aged above 18 years, who were admitted to the emergency room complaining of non-traumatic acute abdominal pain and provided consent for the study.ResultsThe most common diagnoses were acute, nonspecific abdominal pain (37.3%), acute appendicitis (19%), and urinary tract pathology (15.9%). Intra-abdominal free fluid was detected with ultrasonography in 42.5% of patients. Patients with intra-abdominal free fluid were younger than the other patients. The emergency department length of stay was longer in patients with intra-abdominal free fluid (p=0.011). Of the 252 patients enrolled in the study, 32.9% were admitted to the hospital, 21.4% of whom underwent surgery and 11.5% received medical therapy. Most of the patients (64.5%) who were discharged home had no intra-abdominal free fluid in the ultrasonography (p<0.001).ConclusionThe presence of intra-abdominal free fluid alone did not guide the clinical decision regarding the diagnostic evaluation of adult patients that presented to the emergency department complaining of non-traumatic acute abdominal pain.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Significance of Intra-abdominal Free Fluid Detected in Ultrasonography in the Clinical Assessment and Outcomes of Adult Patients Presenting to the Emergency Department Due to Abdominal Pain

Erkek¹,

Aydın²,

Çiftçi³

et al. 2019

Cureus

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“…In other instances, POCUS can obviate the need for further imaging such as in suspected renal and biliary colic 19,20. The use of POCUS to allow reduced utilization of computed tomography (CT) may have a significant public health benefit, with an estimated 1.5–2.0% of all cancers in the United States attributable to radiation from CT 23,24…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective review of pediatric patients with acute abdominal pain, free fluid on diagnostic imaging doubled the rate of a surgical condition from 25% to 57.4% (p<0.001) as well as increased the rate of surgery from 6.3% to 94.4% (p<0.001) 24. While free fluid alone is not specific for a surgical pathology, providers must consider this finding when deciding to obtain or prioritize specialty consults and more specific imaging such as CT in these patients.…”

Section: Discussionmentioning

confidence: 99%

A Curious Case of Right Upper Quadrant Abdominal Pain

Grock¹,

Chan²,

deSouza³

2016

WestJEM

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An otherwise healthy 36-year-old man presented with sudden-onset right upper quadrant abdominal pain and vomiting. A bedside ultrasound, performed to evaluate hepatobiliary pathology, revealed a normal gallbladder but free intraperitoneal fluid. After an expedited CT and emergent explorative laparotomy, the patient was diagnosed with a small bowel obstruction with ischemia secondary to midgut volvulus. Though midgut volvulus is rare in adults, delays in definitive diagnosis and management can result in bowel necrosis. Importantly, an emergency physician must be able to recognize bedside ultrasound findings associated with acutely dangerous intrabdominal pathology.

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“…Final attending radiologist readings of the MRIs and RLQ US were used. Investigators categorized RLQ US and MRI reports as 0 = demonstrating a normal appendix; 1 = not demonstrating the appendix, but not demonstrating any abnormalities consistent with appendicitis (including free‐fluid classified as either physiologic or small without other suggestive findings in adolescent girls); 2 = equivocal (more than physiologic free fluid, lymphadenopathy, inflammation of distal ileum); 3 = not demonstrating the appendix, but demonstrating evidence of appendicitis (abscess, periappendiceal inflammation); 4 = demonstrating an abnormal appendix consistent with appendicitis; or 5 = demonstrating an alternate pathology based on the radiology attending final read.…”

Section: Methodsmentioning

confidence: 99%

Accuracy of Magnetic Resonance Imaging and Ultrasound for Appendicitis in Diagnostic and Nondiagnostic Studies

Kearl

Claudius

Behar

et al. 2016

Academic Emergency Medicine

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Objectives: Suggestive radiographic studies with nonvisualization of the appendix can present a challenge to clinicians in the evaluation of pediatric abdominal pain. The primary objective of this study was to quantify the accuracy of magnetic resonance imaging (MRI) and of ultrasound (US) in the setting of nonvisualization of the appendix. Secondary objectives reported include sensitivity of MRI and US overall and correlation between MRI and US for diagnosis of appendicitis.Methods: Records of pediatric emergency department patients aged 3 to 21 years undergoing MRI and/ or US for the evaluation of appendicitis were retrospectively reviewed. Radiographs were categorized as a normal appendix, neither demonstrating the appendix nor demonstrating abnormalities consistent with appendicitis; equivocal, not demonstrating the appendix but showing evidence of appendicitis; demonstrating an abnormal appendix consistent with appendicitis; or demonstrating an alternate pathology. The reading was compared with the final diagnosis for accuracy.Results: Of the 589 patients included, 146 had appendicitis. Diagnostic accuracy for studies with a nonvisualized appendix without secondary signs of appendicitis was 100% for MRI and 91.4% (95% CI = 87.3% to 94.2%) for US. Diagnostic accuracy for studies with a nonvisualized appendix with secondary signs of appendicitis was 50% (95% CI = 2.5% to 97.5%) for MRI and 38.9% (95% CI = 18.2% to 64.5%) for US. Appendicitis was ultimately diagnosed in 8.6% of patients with an otherwise negative right lower quadrant (RLQ) US that failed to directly identify the appendix. There was a moderate correlation between US and MRI (q = 0.573, p = 0.0001) when all studies were considered.Conclusions: Magnetic resonance imaging without secondary signs of appendicitis is effective in excluding appendicitis regardless of whether the appendix is directly visualized, while otherwise negative RLQ US that fail to identify the appendix are less useful. Secondary signs of appendicitis without visualization of the appendix were not helpful regardless of radiographic modality. Results of MRI and US correlated moderately well.ACADEMIC EMERGENCY MEDICINE 2016;23:179-185

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Clinical Outcomes of Pediatric Patients With Acute Abdominal Pain and Incidental Findings of Free Intraperitoneal Fluid on Diagnostic Imaging

Abstract: We found clinical outcomes (surgical versus nonsurgical) to be most correlated with a surgical diagnosis on diagnostic imaging and not with the amount of fluid present.

Cited by 10 publications

References 7 publications

Significance of Intra-abdominal Free Fluid Detected in Ultrasonography in the Clinical Assessment and Outcomes of Adult Patients Presenting to the Emergency Department Due to Abdominal Pain

Significance of Intra-abdominal Free Fluid Detected in Ultrasonography in the Clinical Assessment and Outcomes of Adult Patients Presenting to the Emergency Department Due to Abdominal Pain

A Curious Case of Right Upper Quadrant Abdominal Pain

Accuracy of Magnetic Resonance Imaging and Ultrasound for Appendicitis in Diagnostic and Nondiagnostic Studies

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