Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

Telesmanich, Morgan E.; Orth, Robert C.; Zhang, Wei; López, Mónica E.; Carpenter, Jennifer L.; Mahmood, Nadia; Jadhav, Siddharth P.; Guillerman, R. Paul

doi:10.1007/s00247-016-3645-4

Cited by 34 publications

(24 citation statements)

References 26 publications

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“…Dalia M et al also show decrease CT usage and US as more promising image modality [ 15 ]. Andreana B et al in their retrospective analysis found average size 6.93 although sample size was small, But, in our observation upper normal value of 6 mm is probably too sensitive [ 7 , 16 , 17 ]. Among these 31 patients, the appendix was either not visualized at all (17 patients) or with secondary signs (14 patients), by the radiologist in all cases, emphasizing the importance of visualization of the appendix.…”

Section: Discussioncontrasting

confidence: 63%

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

Khan

Kitar

Krichen

et al. 2019

Annals of Medicine and Surgery

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BackgroundTo determined the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard.MethodsA prospective evaluations of all ultrasound for appendicitis from January 1, 2014, to June 15, 2017, was conducted at our hospital. A diagnostic protocol was implemented to reduce radiation exposure employing US as the initial imaging modality followed by CT for non-diagnostic US studies in patients with an equivocal clinical presentation. The imaging, operative findings, and pathology of 223 patients (females 80, males 143, age less than 14years) with diagnosed appendicitis were collected. The sensitivity, specificity, predictive value, and negative appendectomy rate were also analyzed. All those patients which had subjected to surgery were included to evaluate the true result of ultrasound in diagnosis of appendicitis.ResultsOf the 223 pediatric appendectomies performed in this time period, a total of 192 (86%) were diagnosed by ultrasound. The histopathology of 8 was normal (3.6%), CT done in 11 and three was normal. The negative appendectomy rate was 3.6%. US were the sole imaging modality in all patients.ConclusionsIn the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure.Study designcross sectional validation.

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Section: Discussioncontrasting

confidence: 63%

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

Khan

Kitar

Krichen

et al. 2019

Annals of Medicine and Surgery

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show abstract

“…Possible confounding factors, such as the length of anamnesis, chronic and/or concomitant diseases, should be excluded and analysed in a following study. In previous trials the association between the diameter of appendix and appendicitis was not found to be statistically significant (7), which would explain why the results in our study were inconclusive. The sample size of patients in whom US was performed, appendix was visualised and the diameter was measured too small for the results to be generalised on whole pediatric population, thus this issue could be addressed in a future studies.…”

Section: Discussioncontrasting

confidence: 90%

Nonsurgical Management of Acute Uncomplicated Appendicitis in Children: the Analysis of Treatment Outcome in Relationship with Antimicrobial Regimens and Adverse Prognostic Factors

Силина

Jurgele

Viksne

et al. 2016

Acta Chirurgica Latviensis

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SummaryIntroduction.For acute appendicitis - the most frequent condition to perform an urgent abdominal operation in pediatric surgery - surgical appendectomy still remains the gold standard regarding treatment, nevertheless nonsurgical management has become more and more recognized as a treatment method for uncomplicated acute appendicitis (UAA). However there are still many unanswered questions regarding possible factors that could predict the treatment outcome as well as appropriate antimicrobial drug regimens.Aim of the Study.The aim was to investigate if there is a possible association between factors such as C-reactive protein (CRP) level, presence of appendicolith, the diameter of the appendix and treatment outcome; as well as to identify most successfully used antimicrobial drug combinations.Material and methods.A retrospective analysis of hospital cases, admitted to a single reference center during the time period from 2013 to 2015. Patients with clinical signs of acute appendicitis, elevated inflammatory markers and radiological findings suggestive for acute appendicitis were included in the study. Nonsurgical treated patients were divided in two groups based on the treatment outcome - successful or unsuccessful. Analysis of the three factors (CRP level, presence of appendicolith and the diameter of the appendix) and most commonly used antimicrobial drug regimen association with treatment outcome was performed.Results.Overall 384 children medical records with acute appendicitis were registered and non-surgical treatment was initiated in 147/384 (38 %) cases. Successful treatment outcome of nonsurgical management was identified in 114/147 (78 %) cases. Analyzing prognostic adverse factors results presents no statistically significant difference in association with CRP level >25 mg/l (p=0,479), presence of appendicolith (p=0,183) and the diameter of appendix >1 cm (p=0,183) with successful or unsuccessful treatment outcome. The two most commonly used antimicrobial drug combinations were - Ampicillin/Metronidazole for 49 patients and Ampicillin/Gentamicin for 44 patients. No relevance with treatment outcome and used antimicrobial agents was detected (p=0,597).The overall recurrence rate after initial presentation is 15 % (17/114). In 3 cases (3 %) recurrent appendicitis developed one month after discharge and in 14 cases (12 %) up to one year after discharge.Conclusions.Prognostic adverse factors - CRP, presence of appendicolith and diameter of appendix - were not statistically reliable in association with initial non-surgical treatment outcome. The success rate of conservative treatment with narrow spectrum antibiotics was 78 %, which is just as high as in cases treated conservatively with broad-spectrum antibiotics from previous studies. Therefore the question of which factors and antimicrobial drug combinations influence the course of treatment still remains unanswered and further studies are required.

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“…In our study, increased vascularity of the appendiceal wall (OR = 6.5; p = 0.005) and peri-appendiceal fat infiltration (OR = 3.9; p = 0.045) were significant US features associated with histologically confirmed appendicitis after surgery. Several previous studies reported similar results to those of our study for the diagnosis of appendicitis in patients with equivocal US exam findings (5,8,16,17). Lim et al (16) and Xu et al (17) reported that the presence of hyperemia in the appendiceal wall through color Doppler US was helpful to diagnose appendicitis in patients with an appendix of equivocal size.…”

Section: Discussionsupporting

confidence: 89%

Useful Ultrasound Findings of Pediatric Patients with Equivocal Results of Appendicitis: Analysis Based on a Structured Report Form

최

김

장

et al. 2021

J Korean Soc Radiol

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Purpose To identify the features that can be used for differentiating appendicitis from non-appendicitis in pediatric patients with equivocal ultrasound (US) results. Materials and Methods A total of 53 pediatric patients (≤ 18 years old) with equivocal results on US examination for suspected appendicitis between November 2012 and October 2017 were included. US evaluation was conducted based on information retrieved from a predefined structured report form. Then, the likelihood of appendicitis was prospectively classified into five categories. The equivocal results were considered as grade 3 (indeterminate) and grade 4 (probably appendicitis). Results Of the 53 patients, 25 (47.2%) and 28 (52.8%) were classified into grade 3 and 4 groups, respectively. Among the individual US findings, increased vascularity of the appendiceal wall and peri-appendiceal fat infiltration were independent findings associated with the diagnosis of appendicitis ( p = 0.005, p = 0.045, respectively) in the multivariate logistic regression analysis and showed the highest diagnostic accuracy (69.8% and 62.3%, respectively). Conclusion Increased vascularity within the appendiceal wall and peri-appendiceal fat infiltration were significant predictors of appendicitis in patients with equivocal US findings.

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Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams

Cited by 34 publications

References 26 publications

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

Nonsurgical Management of Acute Uncomplicated Appendicitis in Children: the Analysis of Treatment Outcome in Relationship with Antimicrobial Regimens and Adverse Prognostic Factors

Useful Ultrasound Findings of Pediatric Patients with Equivocal Results of Appendicitis: Analysis Based on a Structured Report Form

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