Diagnostic Imaging and Negative Appendectomy Rates in Children: Effects of Age and Gender

@article{Bachur2012DiagnosticIA,
  title={Diagnostic Imaging and Negative Appendectomy Rates in Children: Effects of Age and Gender},
  author={Richard G Bachur and Kara E Hennelly and Michael J. Callahan and Catherine Chen and Michael Carl Monuteaux},
  journal={Pediatrics},
  year={2012},
  volume={129},
  pages={877 - 884}
}
BACKGROUND AND OBJECTIVES: Diagnostic imaging is often used in the evaluation of children with possible appendicitis. The utility of imaging may vary according to a patient’s age and gender. The objectives of this study were (1) to examine the use of computed tomography (CT) and ultrasound for age and gender subgroups of children undergoing an appendectomy; and (2) to study the association between imaging and negative appendectomy rates (NARs) among these subgroups. METHODS: Retrospective… 

Figures and Tables from this paper

The Impact of Imaging on Negative Appendectomies for Early Appendicitis in Children
TLDR
It is the hypothesis that children with short onset of symptoms who undergo negative appendectomy often have erroneous imaging findings, and children who had an appendectomy and found to have a normal appendix shared 2 characteristics.
The Role of Imaging in Acute Appendicitis among Children from a Community Hospital
TLDR
A retrospective chart review of hospital data of patients who presented to the Emergency Department with abdominal pain from 2006 to 2010 showed no difference in CT ordering based on clinical presentation, and no significant difference between CT scan order and Alvarado score.
Ultrasonography/MRI Versus CT for Diagnosing Appendicitis
TLDR
In children with suspected acute appendicitis, a radiation-free diagnostic imaging of ultrasonography selectively followed by MRI is feasible and comparable to CT, with no difference in time to antibiotic administration, time to appendectomy, negative appendectomy rate, perforation rate, or length of stay.
Diagnostic Validity and Reliability of Ultrasound in Pediatric Appendicitis
TLDR
Retrospective analysis of a cohort of children younger than 15 years old with acute abdominal pain who underwent abdominal ultrasound for suspected acute appendicitis proved to be reliable and useful in the diagnosis of appendiciti.
Predictors for Acute Appendicitis in Children
TLDR
When the appendix is seen on US but diagnosis of appendicitis is questioned, the absence of inflammatory changes, WBC count of less than 10,000/μL, and appendix diameter of 7 mm or less should decrease suspicion for appendiciti.
...
...

References

SHOWING 1-10 OF 68 REFERENCES
Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children.
TLDR
Data show that CTRC following a negative or indeterminate ultrasonography result is highly accurate in the diagnosis of appendicitis in children.
Effect of an imaging protocol on clinical outcomes among pediatric patients with appendicitis.
TLDR
The implementation of an imaging protocol using US and CT resulted in a marked decrease in the perforation and negative appendectomy rates in children with suspected appendicitis.
Costs and Effectiveness of Ultrasonography and Limited Computed Tomography for Diagnosing Appendicitis in Children
TLDR
A protocol of US followed by CTRC in children with negative or equivocal US examinations results in a high rate of beneficial change in management as well as in total cost savings in children in the emergency department of a large, urban pediatric teaching hospital.
US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis.
TLDR
CT had a significantly higher sensitivity than did US in studies of children and adults; from the safety perspective, however, one should consider the radiation associated with CT, especially in children.
Negative appendectomy rate in the era of CT: an 18-year perspective.
TLDR
There was a significant reduction in both the NAR and the number of appendectomies in patients who presented to the emergency department during an 18-year period, which was associated with a significant increase in the use of preoperative abdominal CT.
CT can reduce hospitalization for observation in children with suspected appendicitis
TLDR
It is suggested that when the appendix can be visualized, CTRC can accurately identify a normal appendix and reduce the number of children hospitalized for observation for possible appendicitis.
Sonography of acute appendicitis in children: 7 years experience
TLDR
Although the use of ultrasound to diagnose acute appendicitis in children has excellent results, the decision for surgery remains a clinical one because of the continuing false-negative and false-positive results from sonography.
Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA.
TLDR
A staged US and CT imaging protocol in which US is performed first in children suspected of having acute appendicitis is highly accurate and offers the opportunity to substantially reduce radiation.
...
...