Poonai Naveen, Gregory Jonathan, Thompson Graham, Lim Rod, Van Osch Skylar, Andrusiak Tara, Mekhaiel Sandra, Sangha Gurinder, Seabrook Jamie, Joubert Gary
Western University, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
J Emerg Med. 2014 Jul;47(1):51-8. doi: 10.1016/j.jemermed.2013.11.096. Epub 2014 Mar 27.
Appendicitis is a common pediatric condition requiring urgent surgical intervention to prevent complications. Pelvic ultrasound (US) as a diagnostic aid has become increasingly common. Despite its advantages, evidence suggests US can lead to delayed definitive management.
The objective was to test the hypothesis that US is associated with an increased time to appendectomy in children with acute appendicitis.
A chart review was conducted of all children aged 0-17 years who presented to the pediatric emergency department (ED) with a discharge diagnosis of appendicitis. The primary outcome variable was the interval between initial evaluation to appendectomy between patients who received an US and those who did not.
Of 662 cases included, 424 patients (64%) underwent a pelvic US and 238 patients underwent an appendectomy without US. Median time interval from initial evaluation in the ED by a physician to appendectomy among patients who received an US was 9.7 h (interquartile range [IQR]: 6.8-15.0 h) compared with 5.5 h (IQR: 3.8-8.6 h) among patients who did not receive an US (Mann-Whitney, p < 0.001). The increased time to appendectomy in patients who received an US was dependent on the patient being female and presenting to the ED after hours (univariate analysis of variance test for interaction, p < 0.05).
Female pediatric patients and those presenting after hours that undergo an US have a significantly increased time to appendectomy compared with those who do not undergo diagnostic imaging.
阑尾炎是一种常见的儿科疾病，需要紧急手术干预以预防并发症。盆腔超声（US）作为一种诊断辅助手段已变得越来越普遍。尽管其具有优势，但有证据表明超声可能导致确定性治疗延迟。
目的是检验急性阑尾炎患儿中超声检查与阑尾切除时间延长相关的假设。
对所有0至17岁因出院诊断为阑尾炎而就诊于儿科急诊科（ED）的儿童进行病历回顾。主要结局变量是接受超声检查和未接受超声检查的患者从初始评估到阑尾切除的时间间隔。
在纳入的662例病例中，424例患者（64%）接受了盆腔超声检查，238例患者未进行超声检查直接接受了阑尾切除术。接受超声检查的患者从急诊科医生初始评估到阑尾切除的中位时间间隔为9.7小时（四分位间距[IQR]：6.8 - 15.0小时），而未接受超声检查的患者为5.5小时（IQR：3.8 - 8.6小时）（曼 - 惠特尼检验，p < 0.001）。接受超声检查的患者阑尾切除时间延长取决于患者为女性且在工作时间后就诊于急诊科（交互作用的单因素方差分析检验，p < 0.05）。
与未接受诊断性影像学检查的女性儿科患者和工作时间后就诊的患者相比，接受超声检查的患者阑尾切除时间显著延长。
