Managing radiation exposure in children—reexamining the role of ultrasound in the diagnosis of appendicitis

Thirumoorthi, Arul; Fefferman, Nancy R.; Ginsburg, Howard B.; Kuenzler, Keith A.; Tomita, Sandra

doi:10.1016/j.jpedsurg.2012.09.018

Cited by 46 publications

(31 citation statements)

References 20 publications

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“…Images are usually good because the abdominal wall does not contain much fatty tissue and the abdominal cavity is small. Sonography has good specificity and does not entail irradiation [5], although once again, its sensitivity is not sufficient to have any diagnostic value when used alone in the absence of clinical and laboratory findings [6]. The sensitivity of sonography for the diagnosis of appendicitis increases with the number of studies performed, but the learning curve in children is long and requires teaching the entire team, including residents, how to use it for this diagnosis [7].…”

Section: Discussionmentioning

confidence: 99%

“…For instance, it has been shown that the combination of white blood count (WBC) and C-reactive protein (CRP) is highly sensitive for detection of inflammation and can be used to eliminate the diagnosis of appendicitis when both are normal [1][2][3]. Likewise, the sensitivity of imaging, essentially abdominal sonography, contributes to confirmatory diagnosis of appendicitis, enhances localization of the appendix and the degree of severity of appendicitis [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children

Podevin

Vries

Lardy

et al. 2017

Journal of Visceral Surgery

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Summary Goal:To evaluate physician compliance with use of a diagnostic algorithm for appendicitis in children. Our secondary objective was to determine the impact of the algorithm on diagnostic accuracy and morbidity. Methods: We conducted a clustered randomized trial in eight centers. A total of 866 patients were included and, depending on the period of randomization at particular centers, 543 patients were managed before the formal institution of the diagnostic algorithm; their diagnostic management was compared to that of the subsequent 323 patients. Results: There was a 29.1% mean increase in the use of imaging studies included in the algorithm after algorithm set-up, rising from 50.8 to 79.9% (P < 0.02). When we used a composite endpoint of ''poor results'' (grouping patients with incorrect diagnoses and/or post-operative complications), no statistically significant difference was found between the two periods (85/543 (15.6%) before vs. 45/323 (13.9%) after set-up, P = 0.5). But when the number of incorrect diagnoses of appendicitis made without the use of the algorithm was compared to that of patients who took advantage of the algorithm, the difference was highly significant (67/332 [20.2%] vs. 63/534 [11.8%], P < 0.001), and the rate of unnecessary appendectomy decreased from 11.9 to 5.3% (P < 0.01). Conclusions: Our diagnostic algorithm improved the adherence to good practice for the diagnosis of appendicitis in children, reducing the rates of unnecessary appendectomy and morbidity. This strategy, combining laboratory tests and imaging, should permit pediatric surgeons to adapt their therapeutic approaches to specific cases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children

Podevin

Vries

Lardy

et al. 2017

Journal of Visceral Surgery

View full text Add to dashboard Cite

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“…The clinical diagnosis of appendicitis in children may be especially challenging due to the difficulties in obtaining an accurate history, numerous other childhood disorders that mimic appendicitis, and atypical presentations that often occur in younger children. In the past, a negative appendectomy rate of up to 15% to 25% was common and widely accepted as a necessary consequence of avoiding missed appendicitis (5). No reliable diagnostic method has been developed to confirm or exclude the diagnosis of AP prior to operation so far.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Preoperative Ultrasonography and Pathology Results of Patients Undergoing Appendectomy

Karabulut¹,

Türkyılmaz²,

Sönmez³

et al. 2016

Ann Colorectal Res

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Background: It is still difficult to make the diagnosis of acute appendicitis in children with only clinical examination. Objectives: The present study, retrospectively reviewing the data of the patients that underwent appendectomy, aimed at emphasizing the diagnostic value of ultrasonography findings by comparing them with pathological diagnosis. Patients and Methods: This retrospective study included patients aged under 18, who were operated on for appendicitis between 1 January 2015 and 31 December 2015. The relationship between the pathology results of these patients and the results of preoperative ultrasonography performed for the diagnosis of acute appendicitis was investigated. Results: The study included 100 patients, 42 were female and 58 were male, on whom ultrasonography was performed and whose

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“…Researchers at many parts of the world including the authors feel that USG first followed by limited CT/MRI exclusively as a problem-solving modality in equivocal cases is a much better option than 'CT-first' policy. 8,9,57,58 The role of USG as a screening modality is being re-introduced and reinforced by improving the quality of USG and its reporting. 57,59,60 Current trends show reduction in CT usage and resurgence in use of USG for diagnosis of AA, with encouraging results.…”

Section: Imaging Modality Of Choice -The Big Debatementioning

confidence: 99%

“…8,9,57,58 The role of USG as a screening modality is being re-introduced and reinforced by improving the quality of USG and its reporting. 57,59,60 Current trends show reduction in CT usage and resurgence in use of USG for diagnosis of AA, with encouraging results. Also, the possibility of low-dose CT scan protocols without compromising the diagnostic quality of imaging is being explored, with promising results in last 5 years.…”

Section: Imaging Modality Of Choice -The Big Debatementioning

confidence: 99%

Imaging in acute appendicitis: What, when, and why?

Debnath

George

Ravikumar

2017

Medical Journal Armed Forces India

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m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 3 ( 2 0 1 7 ) 7 4 -7 9 a r tLaboratory results are often non-specific. Imaging has an important role not only in diagnosing appendicitis and its complication but also suggesting alternate diagnosis in appropriate cases. However, there is no universally accepted diagnostic imaging algorithm for appendicitis. Imaging of acute appendicitis needs to be streamlined keeping pros and cons of the available investigative modalities. Radiography has practically no role today in the diagnosis and management of acute appendicitis. Ultrasonography (USG) should be the first line imaging modality for all ages, particularly for children and non-obese young adults including women of reproductive age group. If USG findings are unequivocal and correlate with clinical assessment, no further imaging is needed. In case of equivocal USG findings or clinico-radiological dissociation, follow-up/further imaging (computed tomography (CT) scan/magnetic resonance imaging (MRI)) is recommended. In pediatric and pregnant patients with inconclusive initial USG, MRI is the next option. Routine use of CT scan for diagnosis of AA needs to be discouraged. Our proposed version of a practical imaging algorithm, with USG first and always has been incorporated in the article. #

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Managing radiation exposure in children—reexamining the role of ultrasound in the diagnosis of appendicitis

Cited by 46 publications

References 20 publications

An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children

An easy-to-follow algorithm to improve pre-operative diagnosis for appendicitis in children

Comparison of Preoperative Ultrasonography and Pathology Results of Patients Undergoing Appendectomy

Imaging in acute appendicitis: What, when, and why?

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