Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children
CONTEXT Limited computed tomography with rectal contrast (CTRC) has been shown to be 98% accurate in the diagnosis of appendicitis in the adult population, but data are lacking regarding the accuracy and effectiveness of this technique in diagnosing pediatric appendicitis. OBJECTIVE To determine the...
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| creator | Peña, Barbara M. Garcia Mandl, Kenneth D Kraus, Steven J Fischer, Anne C Fleisher, Gary R Lund, Dennis P Taylor, George A |
| description | CONTEXT Limited computed tomography with rectal contrast (CTRC) has been shown
to be 98% accurate in the diagnosis of appendicitis in the adult population,
but data are lacking regarding the accuracy and effectiveness of this technique
in diagnosing pediatric appendicitis. OBJECTIVE To determine the diagnostic value of a protocol involving ultrasonography
and CTRC in the diagnosis and management of appendicitis in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 139 children and adolescents aged 3 to 21
years (2 patients were older than 18 years) who had equivocal clinical findings
for acute appendicitis and who presented to the emergency department of a
large, urban, pediatric teaching hospital between July and December 1998. INTERVENTIONS Children were first evaluated with pelvic ultrasonography. If the result
was definitive for appendicitis, laparotomy was performed; if ultrasonography
was negative or inconclusive, CTRC was obtained. Patients who did not undergo
laparotomy had telephone follow-up at 2 weeks and medical records of all patients
were reviewed 4 to 6 months after study completion. MAIN OUTCOME MEASURES Specificity, sensitivity, positive predictive value, negative predictive
value, and accuracy of tests based on final diagnoses; surgeons' estimated
likelihood of appendicitis on a scale of 1 to 10 for each case and their case
management plans before imaging, after ultrasonography, and after CTRC. RESULTS A total of 108 patients underwent both ultrasonography and CTRC examinations.
The protocol had a sensitivity of 94%, specificity of 94%, positive predictive
value of 90%, negative predictive value of 97%, and accuracy of 94%. A normal
appendix was identified by ultrasonography in 2 (2.4%) of 83 patients without
appendicitis and by CTRC in 62 (84%) of 74 patients. A negative ultrasonography
result did not change the surgeons' clinical confidence level in excluding
appendicitis (P=.06), while a negative CTRC result
did have a significant effect (P |
| doi_str_mv | 10.1001/jama.282.11.1041 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_70061284</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>191664</ama_id><sourcerecordid>44659013</sourcerecordid><originalsourceid>FETCH-LOGICAL-a465t-59d3d5965a81de49719fcd00c7b20b05130368521a00e2bdfe6c98f0d36cc4d23</originalsourceid><addsrcrecordid>eNpd0U1P3DAQBmCralW2wB0uKEJVb1nGduzYR7T9oNIiLnCOZm1n19vETuPkwL_HwKKi-mLL7-MPzRByRmFJAejVHntcMsWWlOaNin4gCyq4KrnQ6iNZAGhV1pWqjsiXlPaQB-X1Z3KUreYM2IL8eeimEVMMcTvisHssMNhi7Xs_OVusYj_Mz4v72L_lPhTTzhXfPW5DTD69HLjFgFvXuzAVsS2uh8EF642fcpz9auc7O7pwQj612CV3epiPycPPH_erm3J99-v36npdYiXFVAptuRVaClTUukrXVLfGAph6w2ADgnLgUglGEcCxjW2dNFq1YLk0prKMH5Nvr_cOY_w7uzQ1vU_GdR0GF-fU1ACSMlVlePkf3Md5DPlvDaO5UhWTIqOLA5o3vbPNMPoex8fmrYYZfD0ATAa7dsRgfPrndG6QfH7s_JXlnr0LqczZE0GGiKc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>211374265</pqid></control><display><type>article</type><title>Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Peña, Barbara M. Garcia ; Mandl, Kenneth D ; Kraus, Steven J ; Fischer, Anne C ; Fleisher, Gary R ; Lund, Dennis P ; Taylor, George A</creator><creatorcontrib>Peña, Barbara M. Garcia ; Mandl, Kenneth D ; Kraus, Steven J ; Fischer, Anne C ; Fleisher, Gary R ; Lund, Dennis P ; Taylor, George A</creatorcontrib><description>CONTEXT Limited computed tomography with rectal contrast (CTRC) has been shown
to be 98% accurate in the diagnosis of appendicitis in the adult population,
but data are lacking regarding the accuracy and effectiveness of this technique
in diagnosing pediatric appendicitis. OBJECTIVE To determine the diagnostic value of a protocol involving ultrasonography
and CTRC in the diagnosis and management of appendicitis in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 139 children and adolescents aged 3 to 21
years (2 patients were older than 18 years) who had equivocal clinical findings
for acute appendicitis and who presented to the emergency department of a
large, urban, pediatric teaching hospital between July and December 1998. INTERVENTIONS Children were first evaluated with pelvic ultrasonography. If the result
was definitive for appendicitis, laparotomy was performed; if ultrasonography
was negative or inconclusive, CTRC was obtained. Patients who did not undergo
laparotomy had telephone follow-up at 2 weeks and medical records of all patients
were reviewed 4 to 6 months after study completion. MAIN OUTCOME MEASURES Specificity, sensitivity, positive predictive value, negative predictive
value, and accuracy of tests based on final diagnoses; surgeons' estimated
likelihood of appendicitis on a scale of 1 to 10 for each case and their case
management plans before imaging, after ultrasonography, and after CTRC. RESULTS A total of 108 patients underwent both ultrasonography and CTRC examinations.
The protocol had a sensitivity of 94%, specificity of 94%, positive predictive
value of 90%, negative predictive value of 97%, and accuracy of 94%. A normal
appendix was identified by ultrasonography in 2 (2.4%) of 83 patients without
appendicitis and by CTRC in 62 (84%) of 74 patients. A negative ultrasonography
result did not change the surgeons' clinical confidence level in excluding
appendicitis (P=.06), while a negative CTRC result
did have a significant effect (P<.001). Positive
results obtained for either ultrasonography or CTRC significantly affected
surgeons' estimated likelihood of appendicitis (P=.001
and P<.001, respectively). Ultrasonography resulted
in a beneficial change in patient management in 26 (18.7%) of 139 children
while CTRC correctly changed management in 79 (73.1%) of 108. CONCLUSIONS These data show that CTRC following a negative or indeterminate ultrasonography
result is highly accurate in the diagnosis of appendicitis in children.</description><identifier>ISSN: 0098-7484</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.282.11.1041</identifier><identifier>PMID: 10493202</identifier><identifier>CODEN: JAMAAP</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Adolescent ; Appendicitis ; Appendicitis - diagnosis ; Appendicitis - diagnostic imaging ; Appendicitis - therapy ; Biological and medical sciences ; Child ; Child, Preschool ; Children & youth ; Contrast Media ; Diatrizoate Meglumine ; Digestive system ; Emergency Service, Hospital ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Laparotomy ; Medical diagnosis ; Medical sciences ; Predictive Value of Tests ; Prospective Studies ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Sensitivity and Specificity ; Tomography ; Tomography, X-Ray Computed ; Ultrasonic imaging ; Ultrasonography</subject><ispartof>JAMA : the journal of the American Medical Association, 1999-09, Vol.282 (11), p.1041-1046</ispartof><rights>1999 INIST-CNRS</rights><rights>Copyright American Medical Association Sep 15, 1999</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a465t-59d3d5965a81de49719fcd00c7b20b05130368521a00e2bdfe6c98f0d36cc4d23</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jama/articlepdf/10.1001/jama.282.11.1041$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.282.11.1041$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,777,781,3327,27905,27906,76238,76241</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1928264$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10493202$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Peña, Barbara M. Garcia</creatorcontrib><creatorcontrib>Mandl, Kenneth D</creatorcontrib><creatorcontrib>Kraus, Steven J</creatorcontrib><creatorcontrib>Fischer, Anne C</creatorcontrib><creatorcontrib>Fleisher, Gary R</creatorcontrib><creatorcontrib>Lund, Dennis P</creatorcontrib><creatorcontrib>Taylor, George A</creatorcontrib><title>Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>CONTEXT Limited computed tomography with rectal contrast (CTRC) has been shown
to be 98% accurate in the diagnosis of appendicitis in the adult population,
but data are lacking regarding the accuracy and effectiveness of this technique
in diagnosing pediatric appendicitis. OBJECTIVE To determine the diagnostic value of a protocol involving ultrasonography
and CTRC in the diagnosis and management of appendicitis in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 139 children and adolescents aged 3 to 21
years (2 patients were older than 18 years) who had equivocal clinical findings
for acute appendicitis and who presented to the emergency department of a
large, urban, pediatric teaching hospital between July and December 1998. INTERVENTIONS Children were first evaluated with pelvic ultrasonography. If the result
was definitive for appendicitis, laparotomy was performed; if ultrasonography
was negative or inconclusive, CTRC was obtained. Patients who did not undergo
laparotomy had telephone follow-up at 2 weeks and medical records of all patients
were reviewed 4 to 6 months after study completion. MAIN OUTCOME MEASURES Specificity, sensitivity, positive predictive value, negative predictive
value, and accuracy of tests based on final diagnoses; surgeons' estimated
likelihood of appendicitis on a scale of 1 to 10 for each case and their case
management plans before imaging, after ultrasonography, and after CTRC. RESULTS A total of 108 patients underwent both ultrasonography and CTRC examinations.
The protocol had a sensitivity of 94%, specificity of 94%, positive predictive
value of 90%, negative predictive value of 97%, and accuracy of 94%. A normal
appendix was identified by ultrasonography in 2 (2.4%) of 83 patients without
appendicitis and by CTRC in 62 (84%) of 74 patients. A negative ultrasonography
result did not change the surgeons' clinical confidence level in excluding
appendicitis (P=.06), while a negative CTRC result
did have a significant effect (P<.001). Positive
results obtained for either ultrasonography or CTRC significantly affected
surgeons' estimated likelihood of appendicitis (P=.001
and P<.001, respectively). Ultrasonography resulted
in a beneficial change in patient management in 26 (18.7%) of 139 children
while CTRC correctly changed management in 79 (73.1%) of 108. CONCLUSIONS These data show that CTRC following a negative or indeterminate ultrasonography
result is highly accurate in the diagnosis of appendicitis in children.</description><subject>Adolescent</subject><subject>Appendicitis</subject><subject>Appendicitis - diagnosis</subject><subject>Appendicitis - diagnostic imaging</subject><subject>Appendicitis - therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Children & youth</subject><subject>Contrast Media</subject><subject>Diatrizoate Meglumine</subject><subject>Digestive system</subject><subject>Emergency Service, Hospital</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Laparotomy</subject><subject>Medical diagnosis</subject><subject>Medical sciences</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Sensitivity and Specificity</subject><subject>Tomography</subject><subject>Tomography, X-Ray Computed</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><issn>0098-7484</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0U1P3DAQBmCralW2wB0uKEJVb1nGduzYR7T9oNIiLnCOZm1n19vETuPkwL_HwKKi-mLL7-MPzRByRmFJAejVHntcMsWWlOaNin4gCyq4KrnQ6iNZAGhV1pWqjsiXlPaQB-X1Z3KUreYM2IL8eeimEVMMcTvisHssMNhi7Xs_OVusYj_Mz4v72L_lPhTTzhXfPW5DTD69HLjFgFvXuzAVsS2uh8EF642fcpz9auc7O7pwQj612CV3epiPycPPH_erm3J99-v36npdYiXFVAptuRVaClTUukrXVLfGAph6w2ADgnLgUglGEcCxjW2dNFq1YLk0prKMH5Nvr_cOY_w7uzQ1vU_GdR0GF-fU1ACSMlVlePkf3Md5DPlvDaO5UhWTIqOLA5o3vbPNMPoex8fmrYYZfD0ATAa7dsRgfPrndG6QfH7s_JXlnr0LqczZE0GGiKc</recordid><startdate>19990915</startdate><enddate>19990915</enddate><creator>Peña, Barbara M. Garcia</creator><creator>Mandl, Kenneth D</creator><creator>Kraus, Steven J</creator><creator>Fischer, Anne C</creator><creator>Fleisher, Gary R</creator><creator>Lund, Dennis P</creator><creator>Taylor, George A</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>19990915</creationdate><title>Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children</title><author>Peña, Barbara M. Garcia ; Mandl, Kenneth D ; Kraus, Steven J ; Fischer, Anne C ; Fleisher, Gary R ; Lund, Dennis P ; Taylor, George A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a465t-59d3d5965a81de49719fcd00c7b20b05130368521a00e2bdfe6c98f0d36cc4d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Adolescent</topic><topic>Appendicitis</topic><topic>Appendicitis - diagnosis</topic><topic>Appendicitis - diagnostic imaging</topic><topic>Appendicitis - therapy</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Children & youth</topic><topic>Contrast Media</topic><topic>Diatrizoate Meglumine</topic><topic>Digestive system</topic><topic>Emergency Service, Hospital</topic><topic>Humans</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Laparotomy</topic><topic>Medical diagnosis</topic><topic>Medical sciences</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Radiodiagnosis. Nmr imagery. Nmr spectrometry</topic><topic>Sensitivity and Specificity</topic><topic>Tomography</topic><topic>Tomography, X-Ray Computed</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Peña, Barbara M. Garcia</creatorcontrib><creatorcontrib>Mandl, Kenneth D</creatorcontrib><creatorcontrib>Kraus, Steven J</creatorcontrib><creatorcontrib>Fischer, Anne C</creatorcontrib><creatorcontrib>Fleisher, Gary R</creatorcontrib><creatorcontrib>Lund, Dennis P</creatorcontrib><creatorcontrib>Taylor, George A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Peña, Barbara M. Garcia</au><au>Mandl, Kenneth D</au><au>Kraus, Steven J</au><au>Fischer, Anne C</au><au>Fleisher, Gary R</au><au>Lund, Dennis P</au><au>Taylor, George A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>1999-09-15</date><risdate>1999</risdate><volume>282</volume><issue>11</issue><spage>1041</spage><epage>1046</epage><pages>1041-1046</pages><issn>0098-7484</issn><eissn>1538-3598</eissn><coden>JAMAAP</coden><abstract>CONTEXT Limited computed tomography with rectal contrast (CTRC) has been shown
to be 98% accurate in the diagnosis of appendicitis in the adult population,
but data are lacking regarding the accuracy and effectiveness of this technique
in diagnosing pediatric appendicitis. OBJECTIVE To determine the diagnostic value of a protocol involving ultrasonography
and CTRC in the diagnosis and management of appendicitis in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 139 children and adolescents aged 3 to 21
years (2 patients were older than 18 years) who had equivocal clinical findings
for acute appendicitis and who presented to the emergency department of a
large, urban, pediatric teaching hospital between July and December 1998. INTERVENTIONS Children were first evaluated with pelvic ultrasonography. If the result
was definitive for appendicitis, laparotomy was performed; if ultrasonography
was negative or inconclusive, CTRC was obtained. Patients who did not undergo
laparotomy had telephone follow-up at 2 weeks and medical records of all patients
were reviewed 4 to 6 months after study completion. MAIN OUTCOME MEASURES Specificity, sensitivity, positive predictive value, negative predictive
value, and accuracy of tests based on final diagnoses; surgeons' estimated
likelihood of appendicitis on a scale of 1 to 10 for each case and their case
management plans before imaging, after ultrasonography, and after CTRC. RESULTS A total of 108 patients underwent both ultrasonography and CTRC examinations.
The protocol had a sensitivity of 94%, specificity of 94%, positive predictive
value of 90%, negative predictive value of 97%, and accuracy of 94%. A normal
appendix was identified by ultrasonography in 2 (2.4%) of 83 patients without
appendicitis and by CTRC in 62 (84%) of 74 patients. A negative ultrasonography
result did not change the surgeons' clinical confidence level in excluding
appendicitis (P=.06), while a negative CTRC result
did have a significant effect (P<.001). Positive
results obtained for either ultrasonography or CTRC significantly affected
surgeons' estimated likelihood of appendicitis (P=.001
and P<.001, respectively). Ultrasonography resulted
in a beneficial change in patient management in 26 (18.7%) of 139 children
while CTRC correctly changed management in 79 (73.1%) of 108. CONCLUSIONS These data show that CTRC following a negative or indeterminate ultrasonography
result is highly accurate in the diagnosis of appendicitis in children.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>10493202</pmid><doi>10.1001/jama.282.11.1041</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0098-7484 |
| ispartof | JAMA : the journal of the American Medical Association, 1999-09, Vol.282 (11), p.1041-1046 |
| issn | 0098-7484 1538-3598 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_70061284 |
| source | MEDLINE; American Medical Association Journals |
| subjects | Adolescent Appendicitis Appendicitis - diagnosis Appendicitis - diagnostic imaging Appendicitis - therapy Biological and medical sciences Child Child, Preschool Children & youth Contrast Media Diatrizoate Meglumine Digestive system Emergency Service, Hospital Humans Investigative techniques, diagnostic techniques (general aspects) Laparotomy Medical diagnosis Medical sciences Predictive Value of Tests Prospective Studies Radiodiagnosis. Nmr imagery. Nmr spectrometry Sensitivity and Specificity Tomography Tomography, X-Ray Computed Ultrasonic imaging Ultrasonography |
| title | Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children |
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