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Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children
- Source :
- Journal of pediatric surgery. 51(10)
- Publication Year :
- 2016
-
Abstract
- Ultrasound (US) is the preferred imaging modality for evaluating appendicitis. Our purpose was to determine if including secondary signs (SS) improve diagnostic accuracy in equivocal US studies.Retrospective review identified 825 children presenting with concern for appendicitis and with a right lower quadrant (RLQ) US. Regression models identified which SS were associated with appendicitis. Test characteristics were demonstrated.530 patients (64%) had equivocal US reports. Of 114 (22%) patients with equivocal US undergoing CT, those with SS were more likely to have appendicitis (48.6% vs 14.6%, p0.001). Of 172 (32%) patients with equivocal US admitted for observation, those with SS were more likely to have appendicitis (61.0% vs 33.6%, p0.001). SS associated with appendicitis included fluid collection (adjusted odds ratio (OR) 13.3, 95% confidence interval (CI) 2.1-82.8), hyperemia (OR=2.0, 95%CI 1.5-95.5), free fluid (OR=9.8, 95%CI 3.8-25.4), and appendicolith (OR=7.9, 95%CI 1.7-37.2). Wall thickness, bowel peristalsis, and echogenic fat were not associated with appendicitis. Equivocal US that included hyperemia, a fluid collection, or an appendicolith had 96% specificity and 88% accuracy.Use of SS in RLQ US assists in the diagnostic accuracy of appendicitis. SS may guide clinicians and reduce unnecessary CT and admissions.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Diagnostic accuracy
Sensitivity and Specificity
Article
030218 nuclear medicine & medical imaging
Diagnosis, Differential
03 medical and health sciences
0302 clinical medicine
Pediatric surgery
medicine
Right lower quadrant
Humans
Child
Retrospective Studies
Ultrasonography
Retrospective review
business.industry
Retrospective cohort study
General Medicine
medicine.disease
Appendicitis
Quality Improvement
030220 oncology & carcinogenesis
Child, Preschool
Pediatrics, Perinatology and Child Health
Surgery
Female
Radiology
Suspected appendicitis
Differential diagnosis
business
Tomography, X-Ray Computed
Subjects
Details
- ISSN :
- 15315037
- Volume :
- 51
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Journal of pediatric surgery
- Accession number :
- edsair.doi.dedup.....c64997693f34f2bf3312f5604a799224