York Douglas, Smith Angela, Phillips J Duncan, von Allmen Daniel
Division of Pediatric Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
J Pediatr Surg. 2005 Dec;40(12):1908-11. doi: 10.1016/j.jpedsurg.2005.08.004.
Since 1998, the use of advanced radiographic imaging with computed tomography (CT) and/or diagnostic ultrasound (US) has increased dramatically for the diagnosis of acute appendicitis in children. This study investigates the impact of this imaging on the evaluation, management, and outcome of pediatric patients who underwent appendectomy for suspected appendicitis.
Retrospective review of 197 consecutive children with a preoperative diagnosis of acute appendicitis, from January 2002 through May 2004, undergoing appendectomy at a university-affiliated community hospital by pediatric and general surgeons.
Patients were divided into two groups: imaged (n = 106; 54%) and nonimaged (n = 91; 46%). Groups were similar with respect to age, sex, temperature, white blood count, and insurance status. Ninety-seven imaged patients had CT, 6 had US, and 3 had both CT and US. Seventy-one percent of imaging studies were ordered by emergency department physicians and 24% by treating surgeons. Average wait from emergency department triage to operative incision for the imaged and nonimaged groups was 12.1 and 5.4 hours, respectively (P < .0001). Both groups had similar perforation rates (imaged: 15.1%, nonimaged: 14.6%). Negative appendectomy rates were 10.4% (imaged) and 4.4% (nonimaged). Average hospital charges were 11,791 dollars (imaged) and 9360 dollars (nonimaged) (P = .001). Time on antibiotics, complication rates, and length of stay were similar for both groups.
More than half of pediatric patients with suspected appendicitis now undergo advanced imaging and experience a significant delay in surgical treatment with a 26% increase in hospital charges and no clear-cut improvement in diagnostic accuracy nor outcome, when compared with evaluation by the treating surgeons.
自1998年以来，计算机断层扫描（CT）和/或诊断性超声（US）等先进的放射成像技术在儿童急性阑尾炎诊断中的应用急剧增加。本研究调查了这种成像技术对因疑似阑尾炎接受阑尾切除术的儿科患者的评估、管理和结局的影响。
回顾性分析2002年1月至2004年5月期间在一所大学附属社区医院由儿科和普通外科医生为197例术前诊断为急性阑尾炎的连续儿童进行阑尾切除术的情况。
患者分为两组：接受成像检查的（n = 106；54%）和未接受成像检查的（n = 91；46%）。两组在年龄、性别、体温、白细胞计数和保险状况方面相似。106例接受成像检查的患者中，97例进行了CT检查，6例进行了超声检查，3例同时进行了CT和超声检查。71%的成像检查是由急诊科医生开具的，24%是由主治外科医生开具的。接受成像检查组和未接受成像检查组从急诊科分诊到手术切口的平均等待时间分别为12.1小时和5.4小时（P <.0001）。两组的穿孔率相似（接受成像检查组：15.1%，未接受成像检查组：14.6%）。阴性阑尾切除率分别为10.4%（接受成像检查组）和4.4%（未接受成像检查组）。平均住院费用分别为11791美元（接受成像检查组）和9360美元（未接受成像检查组）（P =.001）。两组的抗生素使用时间、并发症发生率和住院时间相似。
现在超过一半的疑似阑尾炎儿科患者接受了先进的成像检查，手术治疗出现显著延迟，住院费用增加26%，与主治外科医生的评估相比，诊断准确性和结局并无明显改善。
