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Ultrasound for Diagnosis of Appendicitis in a Community Hospital Emergency Department has a High Rate of Nondiagnostic Studies.
- Source :
-
The Journal of emergency medicine [J Emerg Med] 2017 Jun; Vol. 52 (6), pp. 833-838. Date of Electronic Publication: 2017 Feb 28. - Publication Year :
- 2017
-
Abstract
- Background: Radiation concerns are changing the way emergency physicians evaluate patients. This is especially prevalent in pediatrics, and exemplified by abdominal pain management. Large academic center-based studies suggest appendix ultrasound (U/S) is sensitive and specific for appendicitis, with low nondiagnostic rates.<br />Objectives: We sought to determine the diagnostic rate of appendix U/S and incidence of follow-up computed tomography (CT) imaging for pediatric patients at a community hospital.<br />Methods: Design: Retrospective cohort.<br />Setting: Emergency department with 85,000 annual visits.<br />Population: Patients younger than 21 years old that had an appendix U/S over a 12-month period. U/S were performed by technicians and interpreted by radiologists. Investigators classified readings as "diagnostic" ("positive" and "negative") or "non-diagnostic" ("borderline" and "appendix not visualized") and identified follow-up CT studies and interpretations.<br />Results: There were 441 pediatric appendix U/S performed; 26% were diagnostic (14% positive for appendicitis, 12% negative) and 74% nondiagnostic (5% borderline, 69% appendix not visualized). Follow-up CT scans were obtained in 19% of all patients, including 8% with positive U/S, 4% negative, 32% borderline, and 22% not visualized. Follow-up CT was nearly four times more likely in the nondiagnostic group than the diagnostic group (23% vs. 6%, p < 0.0001).<br />Conclusion: The utility of U/S to diagnose appendicitis at a community hospital is limited by a high rate of nondiagnostic studies. Some patients with diagnostic U/S even had follow-up CT imaging. To minimize radiation exposure in children, improvements should be made in the performance and acceptance of U/S as the primary modality of abdominal pain imaging at community hospitals.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Abdominal Pain etiology
Adolescent
Appendicitis epidemiology
Child
Child, Preschool
Cohort Studies
Emergency Service, Hospital organization & administration
Emergency Service, Hospital statistics & numerical data
Female
Hospitals, Community organization & administration
Hospitals, Community statistics & numerical data
Humans
Infant
Male
Radiology Information Systems statistics & numerical data
Retrospective Studies
Tomography, X-Ray Computed methods
Ultrasonography methods
United States epidemiology
Young Adult
Appendicitis diagnosis
Ultrasonography statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 0736-4679
- Volume :
- 52
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of emergency medicine
- Publication Type :
- Academic Journal
- Accession number :
- 28258881
- Full Text :
- https://doi.org/10.1016/j.jemermed.2017.01.003