Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound
Objectives The objective was to review the clinical outcomes of children with suspected appendicitis after an ultrasound (US) examination fails to fully visualize the appendix, the diagnostic characteristics of US in children with suspected appendicitis, and the predictive value of secondary signs o...
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| Veröffentlicht in: | Academic emergency medicine 2014-05, Vol.21 (5), p.538-542 |
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| creator | Ross, Marshall J. Liu, Helena Netherton, Stuart J. Eccles, Robin Chen, Ping‐Wei Boag, Graham Morrison, Ellen Thompson, Graham C. Gorelick, Mark H. |
| description | Objectives
The objective was to review the clinical outcomes of children with suspected appendicitis after an ultrasound (US) examination fails to fully visualize the appendix, the diagnostic characteristics of US in children with suspected appendicitis, and the predictive value of secondary signs of appendicitis when the appendix is not fully visualized.
Methods
This was a retrospective health record review of children aged 3 to 17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis. Descriptive statistics and diagnostic test characteristics are reported.
Results
Overall, 968 children had US. The appendix was fully visualized in 442 cases (45.7%), and 526 (54.3%) children had incompletely visualized appendices. The disposition of those with incompletely visualized appendices were as follows: 59.1% were discharged home, 10.5% went directly to the operating room, and 30.4% were admitted to the hospital for further observation. Of those discharged home based on clinical findings after incompletely visualized appendices, fewer than 0.3% ended up having appendicitis. Ultimately 15.6% of children with incompletely visualized appendices had pathology‐confirmed appendicitis. The sensitivity and specificity of US for children with fully visualized appendices were 99.5% (95% confidence interval [CI] = 96.7% to 100%) and 81.3% (95% CI = 75.2% to 86.2%), respectively. The sensitivity and specificity for the presence of any secondary sign in diagnosing appendicitis were 40.2% (95% CI = 29.6% to 51.7%) and 90.6% (95% CI = 87.5% to 93.2%), respectively.
Conclusions
Children with incompletely visualized appendices on US can be safely discharged home based on clinical findings with an acceptable rate of missed appendicitis. Children with nonreassuring clinical examinations following incompletely visualized appendices on US may benefit from further imaging studies prior to appendectomy, to reduce the rate of negative appendectomy. While the presence of secondary signs of inflammation can be used to rule in appendicitis, statistical strength to rule out appendicitis in the absence of secondary signs is insufficient.
Resumen
Objetivos
Revisión de los resultados clínicos de los niños con sospecha de apendicitis tras un examen ecográfico fallido en la visualización completa del apéndice. Se revisaron también las características diagnósticas ecográficas en niños con sospecha de apendicitis, y el valor predictivo de los signos secundari |
| doi_str_mv | 10.1111/acem.12377 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1540697860</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3321734851</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3937-8c549b1c76ea226ead8556528311446062923296f56304c13479655dd8e2e8443</originalsourceid><addsrcrecordid>eNp9kMtKAzEUQIMotlY3foAE3IgwNe_MLEupD1C60OpyGJNbjGQeTmbQ-vWm1ge4MIski5PDzUHokJIxjeusMFCOKeNab6EhlZInTFO2He9EZYmSig_QXgjPhBCpM72LBkykgkkih8jM-87UJQRcL_H0yXnbQoUfXPeEb_vQgOnA4knTQGWdcZ0LuKgsvqrim8ZDB36F713oC-_ef8E3XFd44bu2CHVf2X20syx8gIOvc4QW57O76WVyPb-4mk6uE8MzrpPUSJE9UqMVFIzFzaZSKslSTqkQiiiWMc4ytYwfIsJQLnSmpLQ2BQapEHyETjbepq1feghdXrpgwPuigroPOZUiBtGpIhE9_oM-131bxekixSlJSUbWwtMNZdo6hBaWedO6smhXOSX5On2-Tp9_po_w0ZeyfyzB_qDfrSNAN8Cr87D6R5VPprObjfQDwcGMhQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1531080904</pqid></control><display><type>article</type><title>Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound</title><source>MEDLINE</source><source>Wiley Journals</source><source>Wiley Online Library Free Content</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Ross, Marshall J. ; Liu, Helena ; Netherton, Stuart J. ; Eccles, Robin ; Chen, Ping‐Wei ; Boag, Graham ; Morrison, Ellen ; Thompson, Graham C. ; Gorelick, Mark H.</creator><contributor>Gorelick, Mark H.</contributor><creatorcontrib>Ross, Marshall J. ; Liu, Helena ; Netherton, Stuart J. ; Eccles, Robin ; Chen, Ping‐Wei ; Boag, Graham ; Morrison, Ellen ; Thompson, Graham C. ; Gorelick, Mark H. ; Gorelick, Mark H.</creatorcontrib><description>Objectives
The objective was to review the clinical outcomes of children with suspected appendicitis after an ultrasound (US) examination fails to fully visualize the appendix, the diagnostic characteristics of US in children with suspected appendicitis, and the predictive value of secondary signs of appendicitis when the appendix is not fully visualized.
Methods
This was a retrospective health record review of children aged 3 to 17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis. Descriptive statistics and diagnostic test characteristics are reported.
Results
Overall, 968 children had US. The appendix was fully visualized in 442 cases (45.7%), and 526 (54.3%) children had incompletely visualized appendices. The disposition of those with incompletely visualized appendices were as follows: 59.1% were discharged home, 10.5% went directly to the operating room, and 30.4% were admitted to the hospital for further observation. Of those discharged home based on clinical findings after incompletely visualized appendices, fewer than 0.3% ended up having appendicitis. Ultimately 15.6% of children with incompletely visualized appendices had pathology‐confirmed appendicitis. The sensitivity and specificity of US for children with fully visualized appendices were 99.5% (95% confidence interval [CI] = 96.7% to 100%) and 81.3% (95% CI = 75.2% to 86.2%), respectively. The sensitivity and specificity for the presence of any secondary sign in diagnosing appendicitis were 40.2% (95% CI = 29.6% to 51.7%) and 90.6% (95% CI = 87.5% to 93.2%), respectively.
Conclusions
Children with incompletely visualized appendices on US can be safely discharged home based on clinical findings with an acceptable rate of missed appendicitis. Children with nonreassuring clinical examinations following incompletely visualized appendices on US may benefit from further imaging studies prior to appendectomy, to reduce the rate of negative appendectomy. While the presence of secondary signs of inflammation can be used to rule in appendicitis, statistical strength to rule out appendicitis in the absence of secondary signs is insufficient.
Resumen
Objetivos
Revisión de los resultados clínicos de los niños con sospecha de apendicitis tras un examen ecográfico fallido en la visualización completa del apéndice. Se revisaron también las características diagnósticas ecográficas en niños con sospecha de apendicitis, y el valor predictivo de los signos secundarios de apendicitis cuando el apéndice no es visualizado totalmente.
Metodologia
Revisión retrospectiva de las historias clínicas de los niños entre 3 y 17 años que acudieron a un servicio de urgencias (SU) pediátrico de nivel terciario con sospecha de apendicitis. Se documentaron los estadísticos descriptivos y las características de las pruebas diagnósticas.
Resultados
A un total de 968 niños se les realizó una ecografía. El apéndice se visualizó completamente en 442 casos (45,7%), y en 526 (54.3%) de forma incompleta. La ubicación de aquéllos con una visualización incompleta ecográfica fue la siguiente: un 59,1% fueron dados de alta a domicilio, un 10,5% fue directamente al quirófano y un 30,4% fue ingresado en el hospital para mayor observación. Entre aquéllos dados de alta a domicilio en base a los hallazgos clínicos tras una visualización incompleta ecográfica, menos de un 0,3% acabaron teniendo una apendicitis. Finalmente, un 15,6% de los niños con visualización incompleta tuvo apendicitis confirmada anatomopatológicamente. La sensibilidad y la especificidad de la ecografía para niños con visualización completa del apéndice fuer on de un 99,5% (intervalo de confianza [IC] 95% = 96,7% a 100%), y un 81,3% (IC 95% = 75,2% a 86,2%), respectivamente. La sensibilidad y especificidad para la presencia de cualquier signo secundario en el diagnóstico de apendicitis fue ron de un 40,2% (IC 95% = 29,6% a 51,7%) y un 90,6% (IC 95% = 87,5% a 93,2%), respectivamente.
Conclusiones
Los niños con una visualización incompleta del apéndice en la ecografía pueden ser dados de alta al domicilio de forma segura basándose en los resultados clínicos con un porcentaje aceptable de apendicitis no diagnosticadas. Los niños con exploraciones clínicas no tranquilizadoras tras una visualización incompleta del apéndice en la ecografía pueden beneficiarse de otras pruebas de imagen previamente a la apendicectomía, para reducir el porcentaje de apendicectomias negativas. Mientras que la presencia de signos secundarios de inflamación puede utilizarse para diagnosticar la apendicitis, la potencia estadística para descartar la apendicitis en ausencia de signos secundarios es insuficiente.</description><identifier>ISSN: 1069-6563</identifier><identifier>EISSN: 1553-2712</identifier><identifier>DOI: 10.1111/acem.12377</identifier><identifier>PMID: 24842505</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Acute Disease ; Adolescent ; Alberta ; Appendectomy - statistics & numerical data ; Appendicitis ; Appendicitis - diagnosis ; Appendicitis - diagnostic imaging ; Appendicitis - pathology ; Appendix ; Child ; Child, Preschool ; Children & youth ; Confidence Intervals ; Diagnosis, Differential ; Diagnostic tests ; Emergency medical care ; Emergency Service, Hospital - standards ; Emergency Service, Hospital - statistics & numerical data ; Female ; Humans ; Male ; Outcome and Process Assessment (Health Care) - statistics & numerical data ; Pediatrics ; Predictive Value of Tests ; Retrospective Studies ; Ultrasonic imaging ; Ultrasonography ; United States</subject><ispartof>Academic emergency medicine, 2014-05, Vol.21 (5), p.538-542</ispartof><rights>2014 by the Society for Academic Emergency Medicine</rights><rights>2014 by the Society for Academic Emergency Medicine.</rights><rights>Copyright Hanley & Belfus, Inc. May 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3937-8c549b1c76ea226ead8556528311446062923296f56304c13479655dd8e2e8443</citedby><cites>FETCH-LOGICAL-c3937-8c549b1c76ea226ead8556528311446062923296f56304c13479655dd8e2e8443</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1417,1433,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24842505$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Gorelick, Mark H.</contributor><creatorcontrib>Ross, Marshall J.</creatorcontrib><creatorcontrib>Liu, Helena</creatorcontrib><creatorcontrib>Netherton, Stuart J.</creatorcontrib><creatorcontrib>Eccles, Robin</creatorcontrib><creatorcontrib>Chen, Ping‐Wei</creatorcontrib><creatorcontrib>Boag, Graham</creatorcontrib><creatorcontrib>Morrison, Ellen</creatorcontrib><creatorcontrib>Thompson, Graham C.</creatorcontrib><creatorcontrib>Gorelick, Mark H.</creatorcontrib><title>Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound</title><title>Academic emergency medicine</title><addtitle>Acad Emerg Med</addtitle><description>Objectives
The objective was to review the clinical outcomes of children with suspected appendicitis after an ultrasound (US) examination fails to fully visualize the appendix, the diagnostic characteristics of US in children with suspected appendicitis, and the predictive value of secondary signs of appendicitis when the appendix is not fully visualized.
Methods
This was a retrospective health record review of children aged 3 to 17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis. Descriptive statistics and diagnostic test characteristics are reported.
Results
Overall, 968 children had US. The appendix was fully visualized in 442 cases (45.7%), and 526 (54.3%) children had incompletely visualized appendices. The disposition of those with incompletely visualized appendices were as follows: 59.1% were discharged home, 10.5% went directly to the operating room, and 30.4% were admitted to the hospital for further observation. Of those discharged home based on clinical findings after incompletely visualized appendices, fewer than 0.3% ended up having appendicitis. Ultimately 15.6% of children with incompletely visualized appendices had pathology‐confirmed appendicitis. The sensitivity and specificity of US for children with fully visualized appendices were 99.5% (95% confidence interval [CI] = 96.7% to 100%) and 81.3% (95% CI = 75.2% to 86.2%), respectively. The sensitivity and specificity for the presence of any secondary sign in diagnosing appendicitis were 40.2% (95% CI = 29.6% to 51.7%) and 90.6% (95% CI = 87.5% to 93.2%), respectively.
Conclusions
Children with incompletely visualized appendices on US can be safely discharged home based on clinical findings with an acceptable rate of missed appendicitis. Children with nonreassuring clinical examinations following incompletely visualized appendices on US may benefit from further imaging studies prior to appendectomy, to reduce the rate of negative appendectomy. While the presence of secondary signs of inflammation can be used to rule in appendicitis, statistical strength to rule out appendicitis in the absence of secondary signs is insufficient.
Resumen
Objetivos
Revisión de los resultados clínicos de los niños con sospecha de apendicitis tras un examen ecográfico fallido en la visualización completa del apéndice. Se revisaron también las características diagnósticas ecográficas en niños con sospecha de apendicitis, y el valor predictivo de los signos secundarios de apendicitis cuando el apéndice no es visualizado totalmente.
Metodologia
Revisión retrospectiva de las historias clínicas de los niños entre 3 y 17 años que acudieron a un servicio de urgencias (SU) pediátrico de nivel terciario con sospecha de apendicitis. Se documentaron los estadísticos descriptivos y las características de las pruebas diagnósticas.
Resultados
A un total de 968 niños se les realizó una ecografía. El apéndice se visualizó completamente en 442 casos (45,7%), y en 526 (54.3%) de forma incompleta. La ubicación de aquéllos con una visualización incompleta ecográfica fue la siguiente: un 59,1% fueron dados de alta a domicilio, un 10,5% fue directamente al quirófano y un 30,4% fue ingresado en el hospital para mayor observación. Entre aquéllos dados de alta a domicilio en base a los hallazgos clínicos tras una visualización incompleta ecográfica, menos de un 0,3% acabaron teniendo una apendicitis. Finalmente, un 15,6% de los niños con visualización incompleta tuvo apendicitis confirmada anatomopatológicamente. La sensibilidad y la especificidad de la ecografía para niños con visualización completa del apéndice fuer on de un 99,5% (intervalo de confianza [IC] 95% = 96,7% a 100%), y un 81,3% (IC 95% = 75,2% a 86,2%), respectivamente. La sensibilidad y especificidad para la presencia de cualquier signo secundario en el diagnóstico de apendicitis fue ron de un 40,2% (IC 95% = 29,6% a 51,7%) y un 90,6% (IC 95% = 87,5% a 93,2%), respectivamente.
Conclusiones
Los niños con una visualización incompleta del apéndice en la ecografía pueden ser dados de alta al domicilio de forma segura basándose en los resultados clínicos con un porcentaje aceptable de apendicitis no diagnosticadas. Los niños con exploraciones clínicas no tranquilizadoras tras una visualización incompleta del apéndice en la ecografía pueden beneficiarse de otras pruebas de imagen previamente a la apendicectomía, para reducir el porcentaje de apendicectomias negativas. Mientras que la presencia de signos secundarios de inflamación puede utilizarse para diagnosticar la apendicitis, la potencia estadística para descartar la apendicitis en ausencia de signos secundarios es insuficiente.</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Alberta</subject><subject>Appendectomy - statistics & numerical data</subject><subject>Appendicitis</subject><subject>Appendicitis - diagnosis</subject><subject>Appendicitis - diagnostic imaging</subject><subject>Appendicitis - pathology</subject><subject>Appendix</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children & youth</subject><subject>Confidence Intervals</subject><subject>Diagnosis, Differential</subject><subject>Diagnostic tests</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital - standards</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Outcome and Process Assessment (Health Care) - statistics & numerical data</subject><subject>Pediatrics</subject><subject>Predictive Value of Tests</subject><subject>Retrospective Studies</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><subject>United States</subject><issn>1069-6563</issn><issn>1553-2712</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtKAzEUQIMotlY3foAE3IgwNe_MLEupD1C60OpyGJNbjGQeTmbQ-vWm1ge4MIski5PDzUHokJIxjeusMFCOKeNab6EhlZInTFO2He9EZYmSig_QXgjPhBCpM72LBkykgkkih8jM-87UJQRcL_H0yXnbQoUfXPeEb_vQgOnA4knTQGWdcZ0LuKgsvqrim8ZDB36F713oC-_ef8E3XFd44bu2CHVf2X20syx8gIOvc4QW57O76WVyPb-4mk6uE8MzrpPUSJE9UqMVFIzFzaZSKslSTqkQiiiWMc4ytYwfIsJQLnSmpLQ2BQapEHyETjbepq1feghdXrpgwPuigroPOZUiBtGpIhE9_oM-131bxekixSlJSUbWwtMNZdo6hBaWedO6smhXOSX5On2-Tp9_po_w0ZeyfyzB_qDfrSNAN8Cr87D6R5VPprObjfQDwcGMhQ</recordid><startdate>201405</startdate><enddate>201405</enddate><creator>Ross, Marshall J.</creator><creator>Liu, Helena</creator><creator>Netherton, Stuart J.</creator><creator>Eccles, Robin</creator><creator>Chen, Ping‐Wei</creator><creator>Boag, Graham</creator><creator>Morrison, Ellen</creator><creator>Thompson, Graham C.</creator><creator>Gorelick, Mark H.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201405</creationdate><title>Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound</title><author>Ross, Marshall J. ; Liu, Helena ; Netherton, Stuart J. ; Eccles, Robin ; Chen, Ping‐Wei ; Boag, Graham ; Morrison, Ellen ; Thompson, Graham C. ; Gorelick, Mark H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3937-8c549b1c76ea226ead8556528311446062923296f56304c13479655dd8e2e8443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute Disease</topic><topic>Adolescent</topic><topic>Alberta</topic><topic>Appendectomy - statistics & numerical data</topic><topic>Appendicitis</topic><topic>Appendicitis - diagnosis</topic><topic>Appendicitis - diagnostic imaging</topic><topic>Appendicitis - pathology</topic><topic>Appendix</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children & youth</topic><topic>Confidence Intervals</topic><topic>Diagnosis, Differential</topic><topic>Diagnostic tests</topic><topic>Emergency medical care</topic><topic>Emergency Service, Hospital - standards</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Outcome and Process Assessment (Health Care) - statistics & numerical data</topic><topic>Pediatrics</topic><topic>Predictive Value of Tests</topic><topic>Retrospective Studies</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ross, Marshall J.</creatorcontrib><creatorcontrib>Liu, Helena</creatorcontrib><creatorcontrib>Netherton, Stuart J.</creatorcontrib><creatorcontrib>Eccles, Robin</creatorcontrib><creatorcontrib>Chen, Ping‐Wei</creatorcontrib><creatorcontrib>Boag, Graham</creatorcontrib><creatorcontrib>Morrison, Ellen</creatorcontrib><creatorcontrib>Thompson, Graham C.</creatorcontrib><creatorcontrib>Gorelick, Mark H.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Academic emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ross, Marshall J.</au><au>Liu, Helena</au><au>Netherton, Stuart J.</au><au>Eccles, Robin</au><au>Chen, Ping‐Wei</au><au>Boag, Graham</au><au>Morrison, Ellen</au><au>Thompson, Graham C.</au><au>Gorelick, Mark H.</au><au>Gorelick, Mark H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound</atitle><jtitle>Academic emergency medicine</jtitle><addtitle>Acad Emerg Med</addtitle><date>2014-05</date><risdate>2014</risdate><volume>21</volume><issue>5</issue><spage>538</spage><epage>542</epage><pages>538-542</pages><issn>1069-6563</issn><eissn>1553-2712</eissn><abstract>Objectives
The objective was to review the clinical outcomes of children with suspected appendicitis after an ultrasound (US) examination fails to fully visualize the appendix, the diagnostic characteristics of US in children with suspected appendicitis, and the predictive value of secondary signs of appendicitis when the appendix is not fully visualized.
Methods
This was a retrospective health record review of children aged 3 to 17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis. Descriptive statistics and diagnostic test characteristics are reported.
Results
Overall, 968 children had US. The appendix was fully visualized in 442 cases (45.7%), and 526 (54.3%) children had incompletely visualized appendices. The disposition of those with incompletely visualized appendices were as follows: 59.1% were discharged home, 10.5% went directly to the operating room, and 30.4% were admitted to the hospital for further observation. Of those discharged home based on clinical findings after incompletely visualized appendices, fewer than 0.3% ended up having appendicitis. Ultimately 15.6% of children with incompletely visualized appendices had pathology‐confirmed appendicitis. The sensitivity and specificity of US for children with fully visualized appendices were 99.5% (95% confidence interval [CI] = 96.7% to 100%) and 81.3% (95% CI = 75.2% to 86.2%), respectively. The sensitivity and specificity for the presence of any secondary sign in diagnosing appendicitis were 40.2% (95% CI = 29.6% to 51.7%) and 90.6% (95% CI = 87.5% to 93.2%), respectively.
Conclusions
Children with incompletely visualized appendices on US can be safely discharged home based on clinical findings with an acceptable rate of missed appendicitis. Children with nonreassuring clinical examinations following incompletely visualized appendices on US may benefit from further imaging studies prior to appendectomy, to reduce the rate of negative appendectomy. While the presence of secondary signs of inflammation can be used to rule in appendicitis, statistical strength to rule out appendicitis in the absence of secondary signs is insufficient.
Resumen
Objetivos
Revisión de los resultados clínicos de los niños con sospecha de apendicitis tras un examen ecográfico fallido en la visualización completa del apéndice. Se revisaron también las características diagnósticas ecográficas en niños con sospecha de apendicitis, y el valor predictivo de los signos secundarios de apendicitis cuando el apéndice no es visualizado totalmente.
Metodologia
Revisión retrospectiva de las historias clínicas de los niños entre 3 y 17 años que acudieron a un servicio de urgencias (SU) pediátrico de nivel terciario con sospecha de apendicitis. Se documentaron los estadísticos descriptivos y las características de las pruebas diagnósticas.
Resultados
A un total de 968 niños se les realizó una ecografía. El apéndice se visualizó completamente en 442 casos (45,7%), y en 526 (54.3%) de forma incompleta. La ubicación de aquéllos con una visualización incompleta ecográfica fue la siguiente: un 59,1% fueron dados de alta a domicilio, un 10,5% fue directamente al quirófano y un 30,4% fue ingresado en el hospital para mayor observación. Entre aquéllos dados de alta a domicilio en base a los hallazgos clínicos tras una visualización incompleta ecográfica, menos de un 0,3% acabaron teniendo una apendicitis. Finalmente, un 15,6% de los niños con visualización incompleta tuvo apendicitis confirmada anatomopatológicamente. La sensibilidad y la especificidad de la ecografía para niños con visualización completa del apéndice fuer on de un 99,5% (intervalo de confianza [IC] 95% = 96,7% a 100%), y un 81,3% (IC 95% = 75,2% a 86,2%), respectivamente. La sensibilidad y especificidad para la presencia de cualquier signo secundario en el diagnóstico de apendicitis fue ron de un 40,2% (IC 95% = 29,6% a 51,7%) y un 90,6% (IC 95% = 87,5% a 93,2%), respectivamente.
Conclusiones
Los niños con una visualización incompleta del apéndice en la ecografía pueden ser dados de alta al domicilio de forma segura basándose en los resultados clínicos con un porcentaje aceptable de apendicitis no diagnosticadas. Los niños con exploraciones clínicas no tranquilizadoras tras una visualización incompleta del apéndice en la ecografía pueden beneficiarse de otras pruebas de imagen previamente a la apendicectomía, para reducir el porcentaje de apendicectomias negativas. Mientras que la presencia de signos secundarios de inflamación puede utilizarse para diagnosticar la apendicitis, la potencia estadística para descartar la apendicitis en ausencia de signos secundarios es insuficiente.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>24842505</pmid><doi>10.1111/acem.12377</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1069-6563 |
| ispartof | Academic emergency medicine, 2014-05, Vol.21 (5), p.538-542 |
| issn | 1069-6563 1553-2712 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1540697860 |
| source | MEDLINE; Wiley Journals; Wiley Online Library Free Content; EZB-FREE-00999 freely available EZB journals |
| subjects | Acute Disease Adolescent Alberta Appendectomy - statistics & numerical data Appendicitis Appendicitis - diagnosis Appendicitis - diagnostic imaging Appendicitis - pathology Appendix Child Child, Preschool Children & youth Confidence Intervals Diagnosis, Differential Diagnostic tests Emergency medical care Emergency Service, Hospital - standards Emergency Service, Hospital - statistics & numerical data Female Humans Male Outcome and Process Assessment (Health Care) - statistics & numerical data Pediatrics Predictive Value of Tests Retrospective Studies Ultrasonic imaging Ultrasonography United States |
| title | Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-26T05%3A43%3A33IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Outcomes%20of%20Children%20With%20Suspected%20Appendicitis%20and%20Incompletely%20Visualized%20Appendix%20on%20Ultrasound&rft.jtitle=Academic%20emergency%20medicine&rft.au=Ross,%20Marshall%20J.&rft.date=2014-05&rft.volume=21&rft.issue=5&rft.spage=538&rft.epage=542&rft.pages=538-542&rft.issn=1069-6563&rft.eissn=1553-2712&rft_id=info:doi/10.1111/acem.12377&rft_dat=%3Cproquest_cross%3E3321734851%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1531080904&rft_id=info:pmid/24842505&rfr_iscdi=true |