Diagnostic Utilization and Accuracy of Pediatric Appendicitis Imaging at Adult and Pediatric Centers

Jones, Ruth Ellen; Gee, Kristin M.; Preston, Stephanie; Babb, Jacqueline; Beres, Alana L.

doi:10.1016/j.jss.2019.02.047

Cited by 14 publications

(9 citation statements)

References 32 publications

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“…Cross-sectional imaging is a very useful noninvasive method for the evaluation of patients suspected of having acute appendicitis as history and physical examination may not be specific. Many other possible causes of pain in the right iliac fossa that can be diagnosed with ultrasound (US) or computed tomography (CT) are numerous, many of which are nonsurgical entities such as Crohn's disease, infectious enterocolitis, typhlitis, epiploic appendagitis, omental infarction, mesenteric adenitis and pelvic inflammatory disease [ 3 , 4 ]. Therefore, a definitive diagnosis—usually derived at imaging—becomes essential to establish the need for surgery.…”

Section: Introductionmentioning

confidence: 99%

“…Strategies for imaging patients with suspected appendicitis usually revolve around clinical probability of the disease (using one of many available clinical prediction/decision rules), in which—if imaging is to be performed—this may start with CT first, or US first with conditional CT when US is inconclusive [ 5 ]. Specific patients’ demographics put value of an US-first strategy in children and women of child-bearing age as differential diagnoses are often vast and also to reduce radiation burden [ 2 , 4 , 5 ]. For the rest of population, CT is often considered the most appropriate first imaging test owing to its high accuracy for both diagnosis, characterization of appendicitis and strong ability to suggest alternative diagnosis [ 4 ], but value of the US-first strategy with conditional CT or even US re-evaluation after an equivocal CT cannot be understated [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…Specific patients’ demographics put value of an US-first strategy in children and women of child-bearing age as differential diagnoses are often vast and also to reduce radiation burden [ 2 , 4 , 5 ]. For the rest of population, CT is often considered the most appropriate first imaging test owing to its high accuracy for both diagnosis, characterization of appendicitis and strong ability to suggest alternative diagnosis [ 4 ], but value of the US-first strategy with conditional CT or even US re-evaluation after an equivocal CT cannot be understated [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Predictive ability of CT findings in the differentiation of complicated and uncomplicated appendicitis: a retrospective investigation of 201 patients undergone appendectomy at initial admission

et al. 2021

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Background Paradigm shift toward nonoperative management (NOM) of adult appendicitis has made computed tomography (CT) more important than ever, particularly in differentiating complicated from uncomplicated disease. Complete surgical and pathological data of appendicitis in a place where appendectomy at initial admission is a standard of care would allow retrospective review of preoperative CT for performance and predictive ability in identifying those that may benefit from NOM in the future. Results The study included 201 CT scans of consecutive adult patients who presented for appendectomy at initial admission with pathologically confirmed acute appendicitis. Complicated appendicitis referred to gangrene or perforation on pathological or operative findings. The overall CT sensitivity, specificity and accuracy for differentiation of complicated from uncomplicated appendicitis were 87.2%, 75.7% and 81.1%, respectively. The most sensitive CT findings of complicated appendicitis were mucosal enhancement defect (83.2%; 95% CI 74.1–90.0) and moderate-to-severe periappendiceal fat stranding (96.8%; 95% CI 91.1–99.3), both independently predictive of complicated appendicitis with adjusted odds ratios (ORs) of 4.62 (95% CI 1.86–11.51) and 4.41 (95% CI 1.06–18.29), respectively. Phlegmon, fluid collection, extraluminal appendicolith, periappendiceal air and small bowel dilatation had specificity of 98.1–100%. Intraluminal appendicoliths were found more frequently in complicated appendicitis (52.6% vs. 22.6%) but not predictive for this diagnosis. Independent clinical predictors of complicated appendicitis were lack of pain migration (OR 2.06), neutrophilia ≥ 82% (OR (2.87) and symptoms ≥ 24 h (OR 5.84). Conclusions CT findings were highly accurate in differentiating complicated from uncomplicated appendicitis among patients undergone appendectomy at initial admission.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive ability of CT findings in the differentiation of complicated and uncomplicated appendicitis: a retrospective investigation of 201 patients undergone appendectomy at initial admission

et al. 2021

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“…A CT scan can also be performed to further assess the findings of a US or if the pediatric patient has a body mass index of > 30. 36 However, six radiologists in the current study stated that they would select an X-ray and CT as their first choices for diagnosing appendicitis, which may result in unnecessary radiation doses being administered to pediatric patients. In addition, 4% to 16% of the radiologists stated that they would utilize a CT scan instead of a US to diagnose abdominal pathologies.…”

Section: Discussionmentioning

confidence: 87%

“… 26–35 For pediatric patients with suspected appendicitis, the first approach should also be US. 36 If a radiology report is inconclusive, a US can be followed up with a CT scan. A CT scan can also be performed to further assess the findings of a US or if the pediatric patient has a body mass index of > 30.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Pediatric Imaging Modalities Practices of Radiologists and Technologists: A Survey-Based Study

Tajaldeen¹,

Kheiralla²,

Al‐Ghamdi

et al. 2022

JMDH

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Introduction Radiation protection for pediatric patients is the main concern in pediatric computed tomography (CT) due to their sensitive organs, such as the brain and the thyroid glands. Accordingly, an optimization of pediatric CT practices is vital to minimize the radiation dose for this population. Aim To assess the pediatric CT practices of radiologists and technologists in a CT unit. Materials and Methods The study was conducted among 26 hospitals, located in various regions in Saudi Arabia. A total of 200 hard copies of the questionnaire were distributed manually and were collected for analysis. In total, 117 completed surveys were gathered from technologies, while 49 were gathered from radiologists. Results In the case of infants with hydrocephalus, 65% of the radiologists ordered an ultrasound (US), 24% ordered a head CT scan, and 10% ordered a magnetic resonance imaging (MRI) and general X-ray for diagnosis. For pediatric patients complaining of persistent headache, 59% and 27% of the radiologists recommended CT and MRI, respectively, for diagnosis. Conclusion Most of the radiologists utilize CT head scan to diagnose persistent headache (by 59%) and ventriculoperitoneal shunt (VPS) malfunction (by 41%) in pediatric patients compared with the other modalities. The use of CT can increase the risk of later malignancy among pediatric patients due to radiation exposure. Alternative imaging modalities such as US and MRI (non-ionized radiation) should be considered to reduce the ionizing radiation hazards and optimize the current practices of radiologists. Most of the technologists follow radiation protection protocols in this study as 63% of the technologists used lead apron for pediatric patient’s protection. Radiation awareness training for the technologists could improve the knowledge about the benefits of using lead apron and reduce the radiation risks in pediatric patients.

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Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis

Henriksen

Christophersen

Rosenberg

et al. 2023

Langenbecks Arch Surg

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Diagnostic Utilization and Accuracy of Pediatric Appendicitis Imaging at Adult and Pediatric Centers

Cited by 14 publications

References 32 publications

Predictive ability of CT findings in the differentiation of complicated and uncomplicated appendicitis: a retrospective investigation of 201 patients undergone appendectomy at initial admission

Predictive ability of CT findings in the differentiation of complicated and uncomplicated appendicitis: a retrospective investigation of 201 patients undergone appendectomy at initial admission

Evaluation of Pediatric Imaging Modalities Practices of Radiologists and Technologists: A Survey-Based Study

Varying negative appendectomy rates after laparoscopic appendectomy: a systematic review and meta-analysis

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