Role of clinical judgment and tissue harmonic imaging ultrasonography in diagnosis of paediatric acute appendicitis

Zakaria, Ossama M; Sultan, Tamer A; Khalil, Tarek; Wahba, Tamer

doi:10.1186/1749-7922-6-39

Cited by 10 publications

(12 citation statements)

References 31 publications

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“…A study from Spain prospectively evaluated a modified clinical practice guiding score consisting of a clinical examination, laboratory result, and tissue harmonic US when necessary. 39 Although the overall accuracy of this approach was high, the authors did not mention to what extent these methods contributed to the overall guideline success. In contrast, our diagnostic pathway used a lowrisk imaging method with the frequently utilized clinical reassessment and showed that children with equivocal initial US and persistent concern about appendicitis on reassessment are candidates for interval US and surgical consultation, and those without ongoing symptoms on reassessment can be discharged.…”

Section: Discussionmentioning

confidence: 99%

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Schuh

Langer

Kulik

et al. 2015

Academic Emergency Medicine

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Objectives: The primary objective was to determine the diagnostic accuracy of a serial ultrasound (US) clinical diagnostic pathway to detect appendicitis in children presenting to the emergency department (ED). The secondary objective was to examine the diagnostic performance of the initial and interval US and to compare the accuracy of the pathway to that of the initial US.Methods: This was a prospective cohort study of 294 previously healthy children 4 to 17 years old with suspected appendicitis and baseline pediatric appendicitis scores of ≥2, who were managed with the serial US clinical diagnostic pathway. This pathway consisted of an initial US followed by a clinical reassessment in each patient and an interval US and surgical consultation in patients with equivocal initial US and persistent concern about appendicitis. The USs were interpreted by published criteria as positive, negative, or equivocal for appendicitis. Children in whom this pathway did not rule in or rule out appendicitis underwent computed tomography (CT). Cases with missed appendicitis, negative operations, and CTs after the pathway were considered inaccurate. The primary outcome was the diagnostic accuracy of the serial US clinical diagnostic pathway. The secondary outcomes included the test performance of the initial and interval US imaging studies.Results: Of the 294 study children, 111 (38%) had appendicitis. Using the serial US clinical diagnostic pathway, 274 of 294 children (93%, 95% confidence interval [CI] = 90% to 96%) had diagnostically accurate results: 108 of the 111 (97%) appendicitis cases were successfully identified by the pathway without CT scans (two missed and one CT), and 166 of the 183 (91%) negative cases were ruled out without CT scans (14 negative operations and three CTs). The sensitivity of this pathway was 108 of 111 (97%, 95% CI = 94% to 100%), specificity 166 of 183 (91%, 95% CI = 87% to 95%), positive predictive value 108 of 125 (86%; 95% CI = 79% to 92%), and negative predictive value 166 of 169 (98%, 95% CI = 96% to 100%). The diagnostic accuracy of the pathway was higher than that of the initial US alone (274 of 294 vs. 160 of 294; p < 0.0001). Of 123 patients with equivocal initial US, concern about appendicitis subsided on clinical reassessment in 73 (no surgery and no missed appendicitis). Of 50 children with persistent symptoms, 40 underwent interval US and 10 had surgical consultation alone. The interval US confirmed or ruled out appendicitis in 22 of 40 children (55.0%) with equivocal initial US, with one false-positive interval US. Conclusions:The serial US clinical diagnostic pathway in suspected appendicitis has an acceptable diagnostic accuracy that is significantly higher than that of the initial US and results in few CT scans.

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Section: Discussionmentioning

confidence: 99%

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Schuh

Langer

Kulik

et al. 2015

Academic Emergency Medicine

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“…Some studies have included the presence or combination of secondary signs into their criteria to give a more accurate and meaningful diagnosis and creating four possible findings: unequivocally positive (appendix is seen and inflamed), probably positive (appendix was poorly seen or not visualised and secondary signs are present), probably negative (appendix was poorly seen or not seen and no secondary signs) and unequivocally negative (appendix seen and normal) 3, 38, 39, 55. With recent studies demonstrating that up to 46% of ultrasound studies do not visualise the appendix, the value of sonographers recognising that secondary signs are reliable diagnostic corollaries could facilitate better clinical outcomes and decrease the need for potential harm in the form of radiation exposure from CT and or unnecessary surgical procedures from negative appendicectomies 47, 53, 56…”

Section: Resultsmentioning

confidence: 99%

Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

Reddan

Corness

Mengersen

et al. 2016

J of Medical Radiation Sci

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Sonography is an important clinical tool in diagnosing appendicitis in children as it can obviate both exposure to potentially harmful ionising radiation from computed tomography scans and the need for unnecessary appendicectomies. This review examines the diagnostic accuracy of ultrasound in the identification of acute appendicitis, with a particular focus on the the utility of secondary sonographic signs as an adjunct or corollary to traditionally examined criteria. These secondary signs can be important in cases where the appendix cannot be identified with ultrasound and a more meaningful finding may be made by incorporating the presence or absence of secondary sonographic signs. There is evidence that integrating these secondary signs into the final ultrasound diagnosis can improve the utility of ultrasound in cases where appendicitis is expected, though there remains some conjecture about whether they play a more important role in negative or positive prediction in the absence of an identifiable appendix.

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“…It is rare under the age of 2 years. The lifetime risk of acute appendicitis ranges from 7% to 9% [10]. Acute appendicitis presents a challenging problem to caregivers because it must be differentiated from a variety of other conditions that result in acute abdominal pain in childhood and the most common condition requiring emergency abdominal surgery in the pediatric population.…”

Section: Resultsmentioning

confidence: 99%

Ultrasonography (US) in the assessment of pediatric non traumatic gastrointestinal emergencies

et al. 2013

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BackgroundNon traumatic gastrointestinal emergencies in the children and neonatal patient is a dilemma for the radiologist in the emergencies room and they presenting characteristics ultrasound features on the longitudinal and axial axis. The most frequent emergencies are : appendicitis, intussusceptions, hypertrophic pyloric stenosis, volvulus due to intestinal malrotation. The aim of this article is to familiarize the reader with the US features.MethodsA retrospective analysis of 200 ultrasound examinations performed in neonatal and children patients with fever, abdominal pain, leukocytosis, vomiting and diarrhea were evaluated.ResultsOf 200 exame 50 cases of intussusceptions, 100 cases of appendicitis, 20 cases associated with abscess;10 gangrenous appendicitis with absence a color Doppler , and 10 cases of perforated appendicitis at tomography computer integration and 10 cases of volvulus was found.ConclusionsUltrasonography (US) is therefore rapidly becoming an important imaging modality for the evaluation of acute abdominal pain, particularly in pediatric patients, where satisfactory examination is often not achievable for the attending clinicians. US provides excellent anatomic detail on the longitudinally and axial axis .

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Role of clinical judgment and tissue harmonic imaging ultrasonography in diagnosis of paediatric acute appendicitis

Cited by 10 publications

References 31 publications

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Properties of Serial Ultrasound Clinical Diagnostic Pathway in Suspected Appendicitis and Related Computed Tomography Use

Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

Ultrasonography (US) in the assessment of pediatric non traumatic gastrointestinal emergencies

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