Michailidou Maria, Sacco Casamassima Maria G, Karim Omar, Gause Colin, Salazar Jose H, Goldstein Seth D, Abdullah Fizan
Division of Pediatric Surgery, Center for Pediatric Surgical Clinical Trials and Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Pediatr Surg Int. 2015 Apr;31(4):355-61. doi: 10.1007/s00383-015-3669-0. Epub 2015 Feb 21.
To evaluate trends and factors associated with interfacility differences in imaging modality selection in the diagnosis and management of children with suspected acute appendicitis.
We conducted a retrospective review of diagnostic imaging selection and outcomes in patients <20 years of age who underwent appendectomy at a single Children's Hospital from June 2008 to June 2013. These results were then compared with those of referring hospitals.
A total of 232 children underwent appendectomy during the study period. Imaging results contributed to diagnostic and management decisions in 95.3 % of cases. CT scan was utilized as first-line imaging in 50 % of cases. CTs were preferentially performed at referring institutions (78 vs. 46 %, p < 0.001). Children were five times more likely to undergo CT at referring institutions (OR = 5.5, CI 3.0-10.2). Adjusting for demographics and Alvarado score, diagnostic imaging choice was independent of patient's clinical status.
This study demonstrates that initial presentation to a referring hospital independently predicts the use of CT scan for suspected acute appendicitis. Further efforts should be undertaken to develop a clinical pathway that minimizes radiation exposure in the diagnosis of acute appendicitis, with focus on access to pediatric abdominal ultrasound.
评估在疑似急性阑尾炎患儿的诊断和治疗中，与不同医疗机构影像检查方式选择差异相关的趋势和因素。
我们对2008年6月至2013年6月期间在一家儿童医院接受阑尾切除术的20岁以下患者的诊断性影像检查选择及结果进行了回顾性分析。然后将这些结果与转诊医院的结果进行比较。
在研究期间，共有232名儿童接受了阑尾切除术。影像检查结果在95.3%的病例中对诊断和治疗决策有帮助。50%的病例将CT扫描作为一线影像检查。在转诊机构中更倾向于进行CT检查（78%对46%，p<0.001）。在转诊机构中儿童接受CT检查的可能性高出五倍（OR=5.5，CI 3.0-10.2）。在对人口统计学和阿尔瓦拉多评分进行校正后,诊断性影像检查的选择与患者的临床状况无关。
本研究表明，初诊于转诊医院可独立预测疑似急性阑尾炎时CT扫描的使用情况。应进一步努力制定临床路径，以尽量减少急性阑尾炎诊断中的辐射暴露，重点是普及小儿腹部超声检查。
