Suspected appendicitis pathway continues to lower CT rates in children two years after implementation
Publication date: Available online 18 July 2019Source: The American Journal of SurgeryAuthor(s): Lori A. Gurien, Samuel D. Smith, Melvin S. Dassinger, Jeffrey M. Burford, Joseph J. Tepas, Marie CrandallAbstractBackgroundWe implemented a protocol to evaluate pediatric patients with suspected appendicitis using ultrasound as the initial imaging modality. CT utilization rates and diagnostic accuracy were evaluated two years after pathway implementation.MethodsThis was a retrospective observational study of patients
ConclusionThe diagnostic performance of ultrasound using a standardized US technique was similar to that reported in prior studies for detecting perforated appendicitis. Despite low sensitivity, individual ultrasound findings and overall diagnostic impression of “evidence of appendix perforation” remain highly specific.
ConclusionsWe recommend laparoscopic appendectomy and totally extraperitoneal hernia repair with mesh after laparoscopic reduction for Amyand ’s hernia.
ConclusionsDespite its rarity, it is feasible to diagnose SA using PoCUS, as patients presenting with right lower quadrant pain and history of appendectomy are at risk for delayed diagnosis, perforation, and poor outcome. PoCUS may reduce time to diagnosis, time to definitive operative or non-operative management, and minimize morbidity.
Abstract Prior studies elucidate a high predictive value of imaging to diagnose appendicitis in small, regional cohorts. This cross-sectional study uniquely analyzes diagnostic imaging in a national appendectomy population. Using the 2016 ACS NSQIP database, positive predictive values (PPVs) for CT, ultrasound (US), and MRI were evaluated using chi-squared tests. Univariate and multivariate analyses considered patient-specific factors. Imaging was performed in 94.63 per cent of 11,841 appendectomy cases; most frequently via CT (78.69%), then combination CT and US (7.52%), US (7.15%), and MRI (0.30%). CT PPV was hi...
Publication date: Available online 25 May 2019Source: The American Journal of SurgeryAuthor(s): Itamar Ashkenazi, Abdel-Rauf Zeina, Oded OlshaAbstractBackgroundWe determined whether increasing early imaging (in the emergency department) was associated with earlier surgery and a decrease in complicated appendicitis.MethodsRetrospective study; 3013 operations between 12/2006-12/2016.ResultsEarly imaging increased from 13.1% to 74.1%, mostly due to increasing use of ultrasound. Negative appendectomies decreased from 10.7% to 5.1% (p
Publication date: May 2019Source: Journal of the American College of Radiology, Volume 16, Issue 5, SupplementAuthor(s): Expert Panel on Pediatric Imaging:, George C. Koberlein, Andrew T. Trout, Cynthia K. Rigsby, Ramesh S. Iyer, Adina L. Alazraki, Sudha A. Anupindi, Dianna M.E. Bardo, Brandon P. Brown, Sherwin S. Chan, Tushar Chandra, Jonathan R. Dillman, Scott R. Dorfman, Richard A. Falcone, Matthew D. Garber, Madeline M. Joseph, Jie C. Nguyen, Nabile M. Safdar, Boaz KarmazynAbstractAcute appendicitis represents the most common abdominal surgical urgency/emergency in children. Imaging remains a central tool in the diagno...
ConclusionsYoung women are particularly at risk for NA. Increasing the use of preoperative CT and incorporating imaging into the overall assessment of a patient seems to be actually the only way to reduce the incidence of NA without increasing the rates of perforation. Considering the relatively high morbidity after an NA procedure, every surgeon must carefully consider the risk –benefit balance prior to performing an appendectomy during diagnostic laparoscopy for suspected acute appendicitis showing a macroscopically noninflamed appendix.
Rationale: Acute appendicitis is one of the most common causes of acute abdomen in children, yet it is difficult to diagnose in young children because its clinical manifestations may be atypical. Here, 3 atypical clinical cases associated with appendicitis in children are reported. Patient concern: The 1st case corresponds to a 5-year-old male patient who presented with abdominal discomfort, intermittent fevers, and vomiting, have increased white blood cell (WBC) count and C-reactive protein (CRP). The second case is a 7-year-old male patient who began with intermittent fevers and lower quadrant abdominal pain, showin...
ConclusionsThe NAR in the 2016 ACS-NSQIP population is 4.5%. CTs are the most frequently used imaging modality and have the lowest NAR. Obtaining a CT in addition to an ultrasound is associated with lower NAR. This should be further explored with a cost-benefit analysis between multiple imaging studies versus negative appendectomies.
ConclusionsIn the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure.Study designcross sectional validation.