Doniger Stephanie J, Kornblith Aaron
Pediatr Emerg Care. 2018 Feb;34(2):109-115. doi: 10.1097/PEC.0000000000000773.
We hypothesized that point-of-care ultrasound (POCUS) is as accurate as radiology-performed ultrasound in evaluating children with clinical concern for appendicitis. As part of a staged approach, we further hypothesized that POCUS could ultimately decrease computed tomography (CT) utilization.
This was a prospective, convenience sampling of patients aged 2 to 18 years presenting with abdominal pain to a pediatric emergency department. Those patients with prior abdominal imaging, pregnant, or unable to tolerate the examination were excluded. An algorithm was followed: POCUS was first performed, followed by a radiology-performed ultrasound, and then a CT as necessary. The main outcome measure was the accuracy of the POCUS in diagnosing of appendicitis. This was compared with radiology-performed ultrasound. We also examined whether certain patient or clinical characteristics influenced the performance of POCUS. Lastly, we determined the amount by which CT scans were decreased through this staged algorithm.
Forty patients were enrolled and underwent a POCUS examination. A total of 16 (40%) had pathology-confirmed appendicitis. Point-of-care ultrasound had a sensitivity of 93.8% (95% confidence interval [CI], 69.7%-98.9%) and specificity of 87.5% (95% CI, 67.6%-97.2%). Radiology-performed ultrasound had a sensitivity of 81.25% (95% CI, 54.3%-95.7%) and specificity of 100% (95% CI, 85.6%-100%). The radiology-performed and POCUS examinations had very good agreement (κ = 0.83, P < 0.0005). Patient characteristics including body mass index did not have an affect on the POCUS. However, POCUS identified all patients with an Alvarado score higher than 6. Overall, the reduction in CT examinations was 55%.
In pediatric patients presenting with clinical concern for acute appendicitis, a staged algorithm that incorporates POCUS is accurate and has the potential to decrease CT scan utilization.
我们假设，在评估临床怀疑阑尾炎的儿童时，床旁超声（POCUS）与放射科进行的超声检查准确性相同。作为分阶段方法的一部分，我们进一步假设POCUS最终可以减少计算机断层扫描（CT）的使用。
这是一项对2至18岁因腹痛就诊于儿科急诊科的患者进行的前瞻性便利抽样研究。排除那些之前有腹部影像学检查、怀孕或无法耐受检查的患者。遵循一种算法：首先进行POCUS检查，然后进行放射科的超声检查，必要时再进行CT检查。主要结局指标是POCUS诊断阑尾炎的准确性。将其与放射科的超声检查进行比较。我们还检查了某些患者或临床特征是否会影响POCUS的表现。最后，我们确定通过这种分阶段算法CT扫描减少的数量。
40名患者入组并接受了POCUS检查。共有16名（40%）患者经病理证实患有阑尾炎。床旁超声的敏感性为93.8%（95%置信区间[CI]，69.7%-98.9%），特异性为87.5%（95%CI，67.6%-97.2%）。放射科的超声检查敏感性为81.25%（95%CI，54.3%-95.7%），特异性为100%（95%CI，85.6%-100%）。放射科的超声检查和POCUS检查一致性非常好（κ=0.83，P<0.0005）。包括体重指数在内的患者特征对POCUS没有影响。然而，POCUS识别出所有阿尔瓦拉多评分高于6分的患者。总体而言，CT检查减少了55%。
在临床怀疑急性阑尾炎的儿科患者中，采用POCUS的分阶段算法准确，并且有可能减少CT扫描的使用。
