Evaluation of Acute Appendicitis by Pediatric Emergency Physician Sonography

Sivitz, Adam; Cohen, Stephanie G.; Tejani, Cena

doi:10.1016/j.annemergmed.2014.03.028

Cited by 61 publications

(64 citation statements)

References 48 publications

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“…1, an appendicolith , a target sign with five concentric layers , high echogenicity surrounding the appendix, , pericecal and perivesical free fluid, and thickened bowel loops with deceased peristalsis [69]. Its sensitivity and specificity range from 80 to 92% and 86 to 98%, respectively [70–73]. In meta-analysis of 26 studies evaluating the role of ultrasound in diagnosis of AP in 9356, the pooled sensitivity were 88%( 95% CI = 86–90), and specificities were 94% ( CI = 92–95) [74].…”

Section: Investigationsmentioning

confidence: 99%

Acute appendicitis in young children less than 5 years: review article

2017

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Despite wide spread availability of sophisticated diagnostic imaging, acute appendicitis in pre-school children remains a diagnostic challenge. Most of these children present late, often with complications e.g. appendicular perforation, abscess formation and peritonitis and as result hospital stay is prolonged and is associated with increased morbidity and mortality.The purpose of this article is to review peculiar features of acute appendicitis in preschool children.

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Section: Investigationsmentioning

confidence: 99%

Acute appendicitis in young children less than 5 years: review article

2017

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“…Radiologists and pediatric emergency medicine sonographers achieved similar sensitivity (60.0% vs 62.5%) and specificity (94% vs 99%), respectively. A second study by Sivitz et al 53 used an anatomically based scanning protocol that improved appendix visualization relative to POC ultrasound studies insonating at the site of maximal tenderness. In the 264 POC ultrasound evaluations, sensitivity and specificity were 85% and 93%, respectively.…”

mentioning

confidence: 99%

Point-of-Care Ultrasound in Pediatric Clinical Care

McLario

Sivitz

2015

JAMA Pediatr

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Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such as Aweil, South Sudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat children with antibiotics who only have viral LRTIs. Point-of-care ultrasound (POCUS) has been applied to LRTIs, but not by nonphysician clinicians, and with limited data from low-resource settings. Our goal was to examine the feasibility of training the mid-level provider cadre clinical officers (COs) in a Médecins Sans Frontières project in South Sudan to perform a POCUS algorithm to differentiate among causes of LRTI. Six COs underwent POCUS training, and each subsequently performed 60 lung POCUS studies on hospitalized pediatric patients < 5 years old with criteria for pneumonia. Two blinded experts, with a tiebreaker expert adjudicating discordant results, served as a reference standard to calculate test performance characteristics, assessed image quality and CO interpretation. The COs performed 360 studies. Reviewers rated 99.1% of the images acceptable and 86.0% CO interpretations appropriate. The inter-rater agreement (κ) between COs and experts for lung consolidation with air bronchograms was 0.73 (0.63-0.82) and for viral LRTI/bronchiolitis was 0.81 (0.74-0.87). It is feasible to train COs in South Sudan to use a POCUS algorithm to diagnose pneumonia and other pulmonary diseases in children < 5 years old.

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“…Sivitz et al [28], with 264 POCUS studies by PEM fellows and attendings, found a sensitivity of 85 % (95 % CI 75–95), specificity of 93 % (85–100), positive likelihood ratio of 11.7 (6.9–20), and negative likelihood ratio of 0.17 (0.1–0.28). Elikashvili et al [29], looking at 150 patients also demonstrated the specificity of PEM-performed POCUS to be 94 % (95 % CI 88–97), indicating that a positive POCUS exam can be acceptable as a rule-in study.…”

Section: Diagnostic Applications Of Ultrasoundmentioning

confidence: 99%

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

et al. 2016

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The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

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Evaluation of Acute Appendicitis by Pediatric Emergency Physician Sonography

Cited by 61 publications

References 48 publications

Acute appendicitis in young children less than 5 years: review article

Acute appendicitis in young children less than 5 years: review article

Point-of-Care Ultrasound in Pediatric Clinical Care

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

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