Integration of radiology and clinical score in pediatric appendicitis

Aydın, Derya; Turan, Caner; Yurtseven, Ali; Bayındır, Petek; B, Toker; Dökümcü, Zafer; Sezak, Murat; Saz, Eylem Ulaş

doi:10.1111/ped.13471

Cited by 11 publications

(11 citation statements)

References 20 publications

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“…Multiple clinical decision tools to aid in the diagnosis of pediatric appendicitis have been described. 41,42 They vary widely in their congruence to published criteria for rigor in clinical decision rules. 22,43 Two of the more well-studied scores include the PAS and Alvarado scores.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting

Cotton

Vinson

Vazquez‐Benitez

et al. 2019

Annals of Emergency Medicine

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The pediatric Appendicitis Risk Calculator (pARC) is a validated clinical tool for assessing a child's probability of appendicitis. Our objective was to assess the performance of the pARC in community emergency departments (EDs) and to compare its performance with that of the Pediatric Appendicitis Score (PAS).Methods: We conducted a prospective validation study from October 1, 2016, to April 30, 2018, in 11 community EDs serving general populations. Patients aged 5 to 20.9 years and with a chief complaint of abdominal pain and less than or equal to 5 days of right-sided or diffuse abdominal pain were eligible for study enrollment. Our primary outcome was the presence or absence of appendicitis within 7 days of the index visit. We reported performance characteristics and secondary outcomes by pARC risk strata and compared the receiver operator characteristic (ROC) curves of the PAS and pARC.Results: We enrolled 2,089 patients with a mean age of 12.4 years, 46% of whom were male patients. Appendicitis was confirmed in 353 patients (16.9%), of whom 55 (15.6%) had perforated appendixes. Fifty-four percent of patients had very low (<5%) or low (5% to 14%) predicted risk, 43% had intermediate risk (15% to 84%), and 4% had high risk (!85%). In the very-lowand low-risk groups, 1.4% and 3.0% of patients had appendicitis, respectively. The area under the ROC curve was 0.89 (95% confidence interval 0.87 to 0.92) for the pARC compared with 0.80 (95% confidence interval 0.77 to 0.82) for the PAS. Conclusion:The pARC accurately assessed appendicitis risk for children aged 5 years and older in community EDs and the pARC outperformed the PAS.

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Section: Discussionmentioning

confidence: 99%

Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting

Cotton

Vinson

Vazquez‐Benitez

et al. 2019

Annals of Emergency Medicine

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“…23 Previous studies have shown favorable outcomes when selective imaging is used in patients with an intermediate risk of appendicitis. [24][25][26][27] In a prospective, observational cohort study conducted by Saucier et al at an academic pediatric ED, 119 (60%) of enrolled patients were found to be intermediate risk for appendicitis (PAS 4-7). After a period of observation in the ED, the treating physician would reassess the patient and determine the need for a RLQ US.…”

Section: Discussionmentioning

confidence: 99%

Resource utilization and outcomes among children risk stratified by pediatric appendicitis risk calculator at a tertiary pediatric center

Becker

Bergmann

Vazquez‐Benitez

et al. 2022

Academic Emergency Medicine

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Objectives: Appendicitis is a common pediatric condition requiring surgery. The pediatric appendicitis risk calculator (pARC) was recently developed to guide clinical care.The objective of this study is to describe resource utilization and clinical outcomes among children with appendix ultrasound (US) scans risk stratified by pARC score.Methods: Prospective enrolled observational cohort single-center study of children aged 5-18, who had an US for suspected appendicitis. We estimated the rate of appendicitis, rate of equivocal US scans, and resource utilization by pARC score strata.Total adjusted charges were determined for low-risk pARC patients compared to discharged emergency department (ED) patients with abdominal pain and complete blood count (CBC) obtained without advanced abdominal imaging.Results: Over the 13-month study period, 407 children were enrolled. The overall rate of appendicitis was 33.4%, and 199 (49%) were male. The observed rate of appendicitis was 3.3% in those with a pARC score of <15% and 96.8% in those with a pARC score of ≥85%. Of enrolled patients, 152 (37.3%) had a pARC score <15%. Of those with a pARC score of <15%, the negative appendectomy rate was 28.6%, and the rate of equivocal US was 49.3%. The rate of CT scans and hospitalizations was 19% and 23%, respectively. Median total charges for patients with pARC <15% with usual care were $3756. Median total charges for patients presenting to the ED with abdominal pain who had a CBC but no advanced abdominal imaging performed was $2484, indicating a potential savings of $1272 per patient. Conclusions:There is a high rate of resource utilization among patients who are low appendicitis risk by pARC score. Outcome variation by pARC scores presents future opportunity to selectively reduce resource utilization in pediatric patients.

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“…Appendicitis is the most common surgical abdominal emergency in the developed world and developing world (17)(18)(19)(20)(21). Although anatomic variations are less common, most of the surprises encountered during an appendectomy are usually due to the various positions of the appendix.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound features and the diagnostic strategy of subhepatic appendicitis

Zhang

et al. 2020

Ann Transl Med

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Background: This study aimed to compare the differences of ultrasound findings between subhepatic appendicitis and appendicitis at a normal position, then discuss the diagnostic strategies and improve the accuracy of diagnosis.Methods: A retrospective analysis was performed in our hospital. One thousand five hundred ninetyone patients with appendicitis were diagnosed from January 2014 to January 2018. Eighteen patients with subhepatic appendicitis and 25 patients with appendicitis with regular positions were selected randomly as the control group. The difference in ultrasound features between the two groups was studied. Comparisons between the two groups showed statistically significant differences in the frequencies of the fishbone sign, enlarged appendix, appendicoliths, and hyperechoic omental cap (P<0.05).Results: Statistical significance was not observed with the difference in the frequency of whether there was lymphadenectasis (P>0.05) in the abdominal cavity between the two groups. The Pareto chart was drawn to look for the main factors associated. The results of interpretation on the critical points of diagnosis for subhepatic appendicitis: (I) the fishbone sign of a dilated ileum in the right lower abdomen; and (II) the fishbone sign of a dilated ileum in the right lower abdomen + presence of an enlarged appendix in the right upper abdomen.Conclusions: An abnormally dilated ileum in the right lower abdomen -the fishbone sign, is a vital sign leading to the diagnosis of subhepatic appendicitis. The fishbone sign of a dilated ileum in the right lower abdomen + whether there is a vermiform structure is an important diagnostic indicator for subhepatic appendicitis.

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Integration of radiology and clinical score in pediatric appendicitis

Abstract: US or abdominal X-ray in children with possible appendicitis should be integrated with PAS to determine the next steps in management. In the case of discordance between the clinical findings and radiology, prolonged observation or further imaging are recommended.

Cited by 11 publications

References 20 publications

Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting

Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting

Resource utilization and outcomes among children risk stratified by pediatric appendicitis risk calculator at a tertiary pediatric center

Ultrasound features and the diagnostic strategy of subhepatic appendicitis

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