Performance of CT Examinations in Children With Suspected Acute Appendicitis in the Community Setting: A Need for More Education

Kim, Michael E.; Orth, Robert C.; Fallon, Sara C.; López, Mónica E.; Brandt, Mary L.; Zhang, Wei; Bisset, George S.

doi:10.2214/ajr.14.12750

Cited by 23 publications

(7 citation statements)

References 16 publications

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“…Currently, over 50 % of children undergoing appendectomy in North America have radiation based imaging [ 38 ]. This rate is too high [ 39 ] and a tailored approach based on risk is sensible, especially in children. Universal imaging of patients with CT, apart from consuming resources, is not without health risks.…”

Section: Resultsmentioning

confidence: 99%

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Saverio¹,

et al. 2016

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Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

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Section: Resultsmentioning

confidence: 99%

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Saverio¹,

et al. 2016

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“…In a previous study, we found that 98.7% of patients who presented to our hospital with acute appendicitis had a diagnostic US prior to surgery [2]. Only 8.2% underwent evaluation with CT and the majority of CT exams were obtained after an equivocal US.…”

Section: Introductionmentioning

confidence: 82%

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

et al. 2015

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“…In the Guite investigation, the mean effective dose for the unindicated phase was 13.1 milliSieverts (mSv), with 33.3% of total examination radiation dose to the study group resulting from unindicated phases [2]. Kim et al [3] reported on data available from 344 children imaged at outside imaging facilities in the setting of acute abdominal pain/possible appendicitis and found that 40% were imaged with suboptimal technique (e.g., wrong phase or multiphase examinations), with multiphase examinations accounting for 17% (60 of 344); 2% were triplephase CT examinations [3]. Of note, the estimated organ doses for the single-phase examinations between the researchers' institution and those from the outside imaging facilities were not significantly different, implying that headway is being made with dose reduction efforts for individual phases but not for the total number of phases.…”

Section: The Landscapementioning

confidence: 99%

‘Here’s looking at you, kid’ … again? Revisiting multiphase CT in children

Frush

2018

Pediatr Radiol

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This is about multiphase CT and Casablanca, the movie. Stay with me to explore this connection (and what better splicing for radiology than with film). Casablanca was an Academy Award winning movie starring Humphrey Bogart and Ingrid Bergman set in late 1941 in Morocco in Northern Africa. Often listed as one of the top five movies of all time, it is an epic story of love and resistance set in wartime, and in the end it is about making tough decisions in a background of changing times that are at odds with the ease of doing the same old thing … and a friendship forged on a foggy runway.

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Performance of CT Examinations in Children With Suspected Acute Appendicitis in the Community Setting: A Need for More Education

Abstract: CT parameters and radiation doses from single-phase examinations in children with appendicitis were similar at nonpediatric treatment centers and a tertiary care children's hospital. Future educational outreach should focus on optimizing other technical parameters.

Cited by 23 publications

References 16 publications

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

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

‘Here’s looking at you, kid’ … again? Revisiting multiphase CT in children

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