The influence of advanced radiographic imaging on the treatment of pediatric appendicitis
Section snippets
Materials and methods
A retrospective review of medical records of 197 consecutive children with a preoperative diagnosis of acute appendicitis from January 2002 through May 2004 was completed following institutional review board approval. Demographic data including sex, age, and insurance status were collected as well as variables corresponding to preoperative evaluation, management, and postoperative outcomes. Variables included white blood cell (WBC) count, highest preoperative temperature, preoperative imaging
Results
From January 2002 through May 2004, there were 197 pediatric appendectomies performed for a preoperative diagnosis of acute appendicitis. The mean age for the group was 10.5 years (range, 2-17 years). There were 75 females (38%) and 122 males (62%).
Imaging studies were performed in 106 (54%) patients (group A) (Table 1). Ninety-one (46%) patients did not receive an imaging study (group B). There was no significant difference in the sex of the patient with regard to who received an imaging
Discussion
The use of advanced imaging studies for the diagnosis of suspected acute appendicitis in children appears to be routine in some institutions, although others argue for its use only in selective cases, mostly using it in females and equivocal cases [6], [7], [8], [12], [13]. In a recent survey of 344 members of the American Pediatric Surgical Association, 19.8% of respondents report the frequent use of imaging (>67% of cases) for the preoperative evaluation of appendicitis [14]. Although US was
Acknowledgments
The authors thank Gary Koch, PhD, for statistical analysis assistance. DY thanks the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health for a short-term research training grant.
References (18)
- et al.
Pediatric appendectomy
J Pediatr Surg
(1995) - et al.
Diagnosis of acute appendicitis in children using a clinical practice guideline
J Pediatr Surg
(2004) - et al.
Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children
J Pediatr Surg
(2003) - et al.
Appendicitis: the impact of computed tomography imaging on negative appendectomy and perforation rates
Am J Gastroenterol
(1998) - et al.
The management of pediatric appendicitis: a survey of North American pediatric surgeons
J Pediatr Surg
(2004) - et al.
Liberal use of computed tomography scanning does not improve diagnostic accuracy in appendicitis
Am J Surg
(2003) - et al.
The optimal initial management of children with suspected appendicitis: a decision analysis
J Pediatr Surg
(2004) Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts
Pediatr Radiol
(2004)- et al.
Ultrasonic demonstration of the inflamed appendix: case report
Radiology
(1981)
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Appendectomy by Pediatric Surgeons in North Carolina is Associated With Higher Charge Than General Surgeons
2023, Journal of Surgical ResearchDiagnostic performance of emergency physician-performed point-of-care ultrasonography for acute appendicitis: A meta-analysis
2019, American Journal of Emergency MedicineCitation Excerpt :These characteristics can improve decision-making, shorten ED stays, improve prognosis, lower costs, and reduce the cumulative radiation dose. The second attribute is the inclusion of a subgroup analysis for pediatric AA, as these patients are more vulnerable to radiation hazards than adults [53], and approximately 60% of American children who are diagnosed with acute appendicitis undergo preoperative CT [54, 55]. Although the small number of studies (n = 7) that included pediatric patients may limit the interpretation of our findings, the diagnostic performance in pediatric studies was higher than that in studies of adults.
Protocol for suspected pediatric appendicitis limits computed tomography utilization
2015, Journal of Surgical ResearchIs pelvic ultrasound associated with an increased time to appendectomy in Pediatric Appendicitis?
2014, Journal of Emergency MedicineCitation Excerpt :Similarly, in a retrospective review of 197 children with suspected appendicitis, York et al. found a significantly increased time from ED triage to incision in patients who underwent either US or CT imaging (12.1 h) compared with those who did not (5.4 h). There were no differences in diagnostic accuracy or outcomes between imaged and nonimaged patients (15). Garfield et al. retrospectively studied 124 adult and pediatric patients who underwent operative exploration for presumed appendicitis in a teaching hospital (34).
Advanced radiologic imaging for pediatric appendicitis, 2005-2009: Trends and outcomes
2012, Journal of PediatricsCitation Excerpt :When CT was introduced as a diagnostic tool for appendicitis in children, its great diagnostic sensitivity obviated the need for routine admission of patients with equivocal findings for serial examinations.1,32 In addition, CT was expected to identify early cases of appendicitis and thereby reduce the rate of perforation; this decreased rate was inconsistently appreciated in previous investigations and was not associated with CT rates in the present study.33-38 However, our data continue to support the inverse association between diagnostic imaging and lower negative appendectomy rates.9,34-39
Incidence and significance of inconclusive results in ultrasound for appendicitis in children and teenagers
2011, Canadian Association of Radiologists Journal
Presented at the 38th Annual Meeting of the Pacific Association of Pediatric Surgeons, May 22-26, 2005, Vancouver, Canada.