Fraser Lyndsay, O'Neill Katie, Locke Richard, Attaie Morag, Irwin Greg, Kubba Haytham, MacGregor Fiona B
Departments of Otolaryngology, Royal Hospital for Sick Children, Dalnair St, Glasgow G3 8SJ, United Kingdom.
Int J Pediatr Otorhinolaryngol. 2013 Aug;77(8):1248-51. doi: 10.1016/j.ijporl.2013.04.026. Epub 2013 Jun 6.
Cervical lymphadenopathy is common in children and can arise from a wide range of aetiologies. Ultrasound can be a useful imaging tool for initial investigation but is known to be operator dependent. We aimed to compare the content of ultrasound reporting in this clinical scenario before and after the introduction of an evidence-based reporting protocol.
We performed a prospective 8-month pilot study assessing the content of ultrasound reports generated from scans to investigate suspected cervical lymphadenopathy in children referred to our tertiary referral otolaryngology service. We found wide variation in report content and inconsistent reporting of certain radiological features. In response to this we performed a literature search to identify key, clinically relevant ultrasonographic features for cervical lymphadenopathy and then in consultation with our radiology colleagues, devised a protocol to facilitate the reporting of these key features. Content of reports was then prospectively re-audited over a further 8-month period.
23 reports were assessed before and 26 after introduction of the reporting protocol. Fisher's exact test was used to analyse the data. We found a statistically significant (p < 0.05) improvement in the frequency of reporting of various key features such as nodal distribution, shape, echogenicity, calcification, necrosis and vascular pattern.
The introduction of a standardised protocol has helped to streamline the reporting of ultrasounds to investigate cervical lymphadenopathy within our department. In the absence of any national guidelines on the reporting of paediatric neck ultrasound in this scenario, we propose that our protocol could be used by other departments to improve standardisation and as a teaching aid.
颈部淋巴结病在儿童中很常见，病因广泛。超声可作为初步检查的有用成像工具，但已知其依赖操作者。我们旨在比较在引入循证报告方案前后，这种临床情况下超声报告的内容。
我们进行了一项为期8个月的前瞻性试点研究，评估对转诊至我们三级转诊耳鼻喉科服务的疑似儿童颈部淋巴结病进行扫描所产生的超声报告内容。我们发现报告内容差异很大，某些放射学特征的报告不一致。针对此，我们进行了文献检索，以确定颈部淋巴结病的关键、临床相关超声特征，然后与放射科同事协商，制定了一项方案以促进对这些关键特征的报告。然后在接下来的8个月期间对报告内容进行前瞻性重新审核。
在引入报告方案前评估了23份报告，之后评估了26份报告。使用Fisher精确检验分析数据。我们发现，在诸如淋巴结分布、形状、回声性、钙化、坏死和血管模式等各种关键特征的报告频率方面有统计学显著改善（p<0.05）。
引入标准化方案有助于简化我们科室对颈部淋巴结病进行超声检查的报告。在这种情况下，缺乏关于儿科颈部超声报告的任何国家指南，我们建议其他科室可使用我们的方案来提高标准化程度并作为教学辅助工具。
