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Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams.
Telesmanich, Morgan E; Orth, Robert C; Zhang, Wei; Lopez, Monica E; Carpenter, Jennifer L; Mahmood, Nadia; Jadhav, Siddharth P; Guillerman, R Paul.
Afiliação
  • Telesmanich ME; Department of Diagnostic Radiology, Baylor College of Medicine, One Baylor Plaza, Mail Stop BCM 360, Houston, TX, 77030, USA. telesman@bcm.edu.
  • Orth RC; Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
  • Zhang W; Outcomes and Impact Services, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
  • Lopez ME; Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
  • Carpenter JL; Department of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
  • Mahmood N; Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
  • Jadhav SP; Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
  • Guillerman RP; Edward B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
Pediatr Radiol ; 46(11): 1539-45, 2016 Oct.
Article em En | MEDLINE | ID: mdl-27282824
ABSTRACT

BACKGROUND:

Ultrasound (US) is the preferred imaging modality for evaluating suspected pediatric appendicitis. However, borderline appendiceal enlargement or questionable inflammatory changes can confound interpretation and lead to equivocal exams.

OBJECTIVE:

The purpose of this study was to determine which findings on equivocal US exams are most predictive of appendicitis. MATERIALS AND

METHODS:

All US exams performed for suspected pediatric appendicitis from July 1, 2013, through July 9, 2014, were initially interpreted using a risk-stratified scoring system. Two blinded pediatric radiologists independently reviewed US exams designated as equivocal and recorded the following

findings:

increased wall thickness, loss of mural stratification, peri-appendiceal fat inflammation, peri-appendiceal fluid, appendicolith and maximum appendiceal diameter. A third pediatric radiologist resolved discrepancies. US features were correlated with the final diagnosis via multivariate analysis.

RESULTS:

During the study period, 162/3,750 (4.3%) children had US exams initially interpreted as equivocal (mean age 9.8 +/- 3.8 years). Five outpatients were lost to follow-up. Forty-eight of the remaining 157 (30.6%) children had an operative diagnosis of appendicitis. Findings significantly associated with appendicitis were loss of mural stratification (odds ratio [OR] = 6.7, P=0.035), peri-appendiceal fat inflammation (OR = 10.0, P<0.0001) and appendicolith (OR = 15.8, P=0.025). While appendiceal diameter tended to be larger in patients with appendicitis, the difference was not statistically significant.

CONCLUSION:

Loss of mural stratification, peri-appendiceal fat inflammation and an appendicolith are significant predictors of appendicitis in children with otherwise equivocal US exams. While maximum appendiceal diameter is not statistically associated with appendicitis in our study, mean appendiceal diameter of 6.7 mm in those without appendicitis suggests that the customary upper normal limit of 6 mm is too sensitive.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Apendicite / Ultrassonografia Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Apendicite / Ultrassonografia Tipo de estudo: Diagnostic_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adolescent / Adult / Child / Child, preschool / Female / Humans / Infant / Male Idioma: En Ano de publicação: 2016 Tipo de documento: Article