Development and validation of an ultrasound scoring system for children with suspected acute appendicitis

Fallon, Sara C.; Orth, Robert C.; Guillerman, R. Paul; Munden, Martha M.; Zhang, Wei; Elder, Simone C.; Cruz, Andrea T.; Brandt, Mary L.; López, Mónica E.; Bisset, George S.

doi:10.1007/s00247-015-3443-4

Cited by 56 publications

(68 citation statements)

References 26 publications

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“…This has led the Canadian Association of Radiologists (CAR) to recommend that, when abdominal ultrasound (US) is not diagnostic in children with clinical suspicion for acute appendicits, surgeons should treat without other imaging [8]. Abdominal ultrasound scoring systems for evaluating suspected acute appendicits such as the Appy-Score stratification [9] have also been described. After applying the Appy-Score strata, Fallon, et al [9] found that acute appendicits frequency was 0.5% for a normal completely visualized appendix, 0% for a normal partially visualized appendix, and that CT imaging after US decreased by 31%.…”

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

“…Abdominal ultrasound scoring systems for evaluating suspected acute appendicits such as the Appy-Score stratification [9] have also been described. After applying the Appy-Score strata, Fallon, et al [9] found that acute appendicits frequency was 0.5% for a normal completely visualized appendix, 0% for a normal partially visualized appendix, and that CT imaging after US decreased by 31%. Significantly, for equivocal US findings, the acute appendicits frequency was 44%, while for clear evidence of non-perforated or perforated acute appendicits, the frequency was 92.3% and 100%, respectively [9].…”

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

“…After applying the Appy-Score strata, Fallon, et al [9] found that acute appendicits frequency was 0.5% for a normal completely visualized appendix, 0% for a normal partially visualized appendix, and that CT imaging after US decreased by 31%. Significantly, for equivocal US findings, the acute appendicits frequency was 44%, while for clear evidence of non-perforated or perforated acute appendicits, the frequency was 92.3% and 100%, respectively [9]. Ultrasound eliminates radiation but has sensitivity inferior to CT [10].…”

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

“…If the scores do not improve or if the initial PAS score is 7 or more, US should be the initial imaging test. The finding of a normal completely or incompletely visualized appendix can rule out acute appendicits while clear evidence of perforated or nonperforated appendicitis mandates surgery [9]. If the US findings are equivocal, CT scan should be performed in view of its higher sensitivity and PPV [10][11][12].…”

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

“…This combination may be a good option for heavily iron overloaded patients, particularly those are difficult-to-chelate with a suboptimal response to monotherapy. Hematopoietic stem cell transplant (HSCT) is the only curative option for patients with thalassemia major but outcomes are worst in Pesaro Class III patients (who have high iron overload) with overall success rate of 60% [9]. The major cause of mortality is veno-occlusve disease due to high iron content in the liver.…”

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Editorial

Yadav

2016

Indian Pediatr

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Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

Section: E D I T O R I a L E D I T O R I A L E D I T O R I A L E D I mentioning

confidence: 99%

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confidence: 99%

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Yadav

2016

Indian Pediatr

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Nonoperative Treatment of Appendicitis—Reply

Huang

Zhou

2017

JAMA Pediatr

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Huang et al 1 combining results of 5 studies (n = 404 patients) with uncomplicated appendicitis (AUA) evaluating efficacy of nonoperative treatment (NOT). They found NOT was successful in 90% of cases and concluded that antibiotics as the initial treatment for pediatric patients with AUA may be feasible and effective without increasing the risk for complications.I believe there are quality issues characterizing the studies used for the meta-analysis that preclude making these assertions with accuracy regarding NOT safety: 1. Presumably, patients selected for NOT had milder degrees of AUA. In 1 study, 2 inclusion criteria defining NOT eligibility were abdominal imaging showing lesser degrees of appendiceal dilation (0.6-1.1 cm). Yet in prior studies, [3][4][5] nearly half of patients imaged to evaluate for a nonappendicitis condition had a "normal" measured appendiceal diameter of greater than 0.6 cm, raising the possibility that a number of study cases categorized as "milder appendicitis" that "resolved" using NOT may have not actually been appendicitis. 2. An important outcome measure, in-hospital length of stay, was significantly longer in those receiving medical vs surgical treatment. Longer hospital stay affects health care use/cost, inconvenience to families, and potential for iatrogenic complications. 3. Approximately 10% of patients who received NOT were ultimately considered treatment failures; of these, 3 patients developed in-hospital perforated appendicitis while receiving antibiotic therapy, and 5 patients considered to be successfully treated per NOT experienced recurrent appendicitis within 1 month of hospital discharge. An important outcome measure not assessed by these studies is a cost analysis required for the many potential repeated medical evaluation(s) for possible recurrent appendicitis each time the patient who received NOT experienced abdominal pain including ED visits, performance of laboratory testing and advanced imaging, surgical consultation, and possible hospitalization. 4. An essential prerequisite to defining AUA in prior studies comparing NOT vs appendectomy is accurate distinction of nonperforated vs perforated appendicitis. Studies included in the meta-analysis exclusively used pathologist histologic examination to determine this, which has been shown to be highly inaccurate for distinguishing perforation status 6 and may have resulted in misclassification of a substantial proportion of AUA cases as being "without perforation."

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Diagnostic performance of ultrasound to differentiate perforated from non‐perforated paediatric appendicitis: A narrative review

2020

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Appendicitis is the most common reason for urgent paediatric surgery, with significantly higher rates of appendiceal perforation in young children. Distinct management plans are required for perforated and non‐perforated appendicitis and thus accurate differentiation is crucial. Ultrasound is a safe imaging modality that avoids ionising radiation exposure to children and is useful for diagnosis of appendicitis. The aim of this review is to explore the diagnostic performance of ultrasound for detecting perforated paediatric appendicitis and to determine the sonographic findings useful for distinguishing perforated from non‐perforated appendicitis in the paediatric population. Ultrasound demonstrates high specificity ranging from 90% to 100%, but low sensitivity ranging from 23% to 44% for differentiating perforated from non‐perforated appendicitis in children. Sonographic findings significantly associated with perforated paediatric appendicitis include an abscess, loculated or complex intraperitoneal fluid, an appendicolith, dilated bowel and thickening of the terminal ileum, all of which demonstrate high specificity but low sensitivity. The high specificity of ultrasound indicates that it is a useful diagnostic tool to rule out perforated appendicitis and differentiate it from non‐perforated appendicitis in children.

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Development and validation of an ultrasound scoring system for children with suspected acute appendicitis

Abstract: A scoring system and structured template for reporting US exam results for suspected pediatric appendicitis was successfully adopted by a pediatric radiology department at a large tertiary children's hospital and stratifies risk for children based on their likelihood of appendicitis.

Cited by 56 publications

References 26 publications

Editorial

Editorial

Nonoperative Treatment of Appendicitis—Reply

Diagnostic performance of ultrasound to differentiate perforated from non‐perforated paediatric appendicitis: A narrative review

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