The diagnosis of acute appendicitis in a pediatric population: To CT or not to CT

Stephen, Antonia E.; Segev, Dorry L.; Ryan, Daniel P.; Mullins, Mark E.; Kim, Samuel H.; Schnitzer, Jay J.; Doody, Daniel P.

doi:10.1053/jpsu.2003.50110

Cited by 94 publications

(47 citation statements)

References 17 publications

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“…Although the diagnostic accuracy of CT is reported to be higher than that of US, particularly in adults, it is debatable whether CT is able to reduce the negative appendectomy rate in children [14,15].…”

Section: Us or Ct In Children With Suspected Appendicitis?mentioning

confidence: 99%

Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective

Holscher

Heij

2009

Pediatr Radiol

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Section: Us or Ct In Children With Suspected Appendicitis?mentioning

confidence: 99%

Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective

Holscher

Heij

2009

Pediatr Radiol

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“…4 In the ED, a significant proportion of pediatric radiation exposure occurs due to CT scans performed for the diagnosis of appendicitis. 5 Diagnosing appendicitis can be challenging, and the consequences of missing acute appendicitis severe. While the clinical history, exam, and laboratory findings are critical, CT scanning has reduced the number of cases of missed appendicitis as well as the number of negative appendectomies performed.…”

mentioning

confidence: 99%

An Interdisciplinary Initiative to Reduce Radiation Exposure: Evaluation of Appendicitis in a Pediatric Emergency Department With Clinical Assessment Supported by a Staged Ultrasound and Computed Tomography Pathway

Ramarajan

Krishnamoorthi

Barth

et al. 2009

Academic Emergency Medicine

103

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Objectives: In the emergency department (ED), a significant amount of radiation exposure is due to computed tomography (CT) scans performed for the diagnosis of appendicitis. Children are at increased risk of developing cancer from low-dose radiation and it is therefore desirable to utilize CT only when appropriate. Ultrasonography (US) eliminates radiation but has sensitivity inferior to that of CT. We describe an interdisciplinary initiative to use a staged US and CT pathway to maximize diagnostic accuracy while minimizing radiation exposure.Methods: This was a retrospective outcomes analysis of patients presenting after hours for suspected appendicitis at an academic children's hospital ED over a 6-year period. The pathway established US as the initial imaging modality. CT was recommended only if US was equivocal. Clinical and pathologic outcomes from ED diagnosis and disposition, histopathology and return visits, were correlated with the US and CT. ED diagnosis and disposition, pathology, and return visits were used to determine outcome.Results: A total of 680 patients met the study criteria. A total of 407 patients (60%) followed the pathway. Two-hundred of these (49%) were managed definitively without CT. A total of 106 patients (26%) had a positive US for appendicitis; 94 (23%) had a negative US. A total of 207 patients had equivocal US with follow-up CT. A total of 144 patients went to the operating room (OR); 10 patients (7%) had negative appendectomies. One case of appendicitis was missed (<0.5%). The sensitivity, specificity, negative predictive value, and positive predictive values of our staged US-CT pathway were 99%, 91%, 99%, and 85%, respectively. A total of 228 of 680 patients (34%) had an equivocal US with no follow-up CT. Of these patients, 10 (4%) went to the OR with one negative appendectomy. A total of 218 patients (32%) were observed clinically without complications. Conclusions:Half of the patients who were treated using this pathway were managed with definitive US alone with an acceptable negative appendectomy rate (7%) and a missed appendicitis rate of less than 0.5%. Visualization of a normal appendix (negative US) was sufficient to obviate the need for a CT in the authors' experience. Emergency physicians (EPs) used an equivocal US in conjunction with clinical assessment to care for one-third of study patients without a CT and with no known cases of missed appendicitis. These data suggest that by employing US first on all children needing diagnostic imaging for diagnosis of acute appendicitis, radiation exposure may be substantially decreased without a decrease in safety or efficacy.

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“…One of the largest areas of increased use of CT has been seen for paediatric diagnosis. CT has established itself as the main diagnostic tool for appendicitis, replacing ultrasonography [59]. Children are inherently more sensitive than adults to radiation, and they have more years of life in which cancer may develop [58].…”

Section: Biomarkers For Diagnostic and Interventional Radiologymentioning

confidence: 99%

Deoxyribonucleic acid damage-associated biomarkers of ionising radiation: current status and future relevance for radiology and radiotherapy

Manning

Rothkamm²

2013

BJR

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Diagnostic and therapeutic radiation technology has developed dramatically in recent years, and its use has increased significantly, bringing clinical benefit. The use of diagnostic radiology has become widespread in modern society, particularly in paediatrics where the clinical benefit needs to be balanced with the risk of leukaemia and brain cancer increasing after exposure to low doses of radiation. With improving long-term survival rates of radiotherapy patients and the ever-increasing use of diagnostic and interventional radiology procedures, concern has risen over the long-term risks and side effects from such treatments. Biomarker development in radiology and radiotherapy has progressed significantly in recent years to investigate the effects of such use and optimise treatment. Recent biomarker development has focused on improving the limitations of established techniques by the use of automation, increasing sensitivity and developing novel biomarkers capable of quicker results. The effect of low-dose exposure (0-100 mGy) used in radiology, which is increasingly linked to cancer incidences, is being investigated, as some recent research challenges the linear-no-threshold model. Radiotherapy biomarkers are focused on identifying radiosensitive patients, determining the treatment-associated risk and allowing for a tailored and more successful treatment of cancer patients. For biomarkers in any of these areas to be successfully developed, stringent criteria must be applied in techniques and analysis of data to reduce variation among reports and allow data sets to be accurately compared. Newly developed biomarkers can then be used in combination with the established techniques to better understand and quantify the individual biological response to exposures associated with radiology tests and to personalise treatment plans for patients.

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The diagnosis of acute appendicitis in a pediatric population: To CT or not to CT

Cited by 94 publications

References 17 publications

Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective

Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective

An Interdisciplinary Initiative to Reduce Radiation Exposure: Evaluation of Appendicitis in a Pediatric Emergency Department With Clinical Assessment Supported by a Staged Ultrasound and Computed Tomography Pathway

Deoxyribonucleic acid damage-associated biomarkers of ionising radiation: current status and future relevance for radiology and radiotherapy

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