儿科阑尾炎中放射学与临床评分的整合

Integration of radiology and clinical score in pediatric appendicitis.

作者信息

Aydin Derya, Turan Caner, Yurtseven Ali, Bayindir Petek, Toker Bade, Dokumcu Zafer, Sezak Murat, Saz Eylem Ulas

机构信息

Department of Pediatrics, Division of Pediatric Emergency, Ege University School of Medicine, Izmir, Turkey.

Department of Radiology, Division of Pediatric Radiology, Ege University School of Medicine, Izmir, Turkey.

出版信息

Pediatr Int. 2018 Feb;60(2):173-178. doi: 10.1111/ped.13471.

DOI:10.1111/ped.13471

PMID:29205688

Abstract

BACKGROUND

The efficacy of ultrasonography (US) and abdominal X-ray in combination with Pediatric Appendicitis Score (PAS) is complicated in the diagnosis of acute appendicitis. Abdominal X-ray is as useful as US with clinical assessment when evaluated by experienced pediatric radiologist in acute appendicitis. The aim of this study was to determine the value of US and abdominal X-ray for appendicitis in children when combined with clinical assessment based on PAS, and to establish a practical pathway for acute appendicitis in childhood.

METHODS

A prospective, observational cohort study was conducted at an urban, academic pediatric emergency department. Patients were classified at low (PAS 1-4), intermediate (PAS 5-7), or high (PAS 8-10) risk for appendicitis. Low-risk patients were discharged with telephone follow-up in ≤10 days; those at intermediate risk underwent X-ray and US. High-risk patients received immediate surgical consultation. Patients were grouped on histopathology as having either proven acute appendicitis or no appendicitis.

RESULTS

A total of 288 children were analyzed. Surgery was performed in 134 patients (46.5%), and 128 (95.5%) had positive histopathology. Mean PAS in the patients with and without appendicitis was 7.09 ± 1.42 and 4.97 ± 2.29, respectively (P = 0.00). The rate of missed cases was 6/288 (2%), and the negative appendectomy rate was 6/134 (4.4%). When the score cut-off was set at 6, the sensitivity and specificity of PAS was 86.7% and 63.1%, respectively. The diagnostic performance of daytime US had a sensitivity of 91.1% and specificity of 71.1%. Also, positive US or PAS >6 or both, had sensitivity and specificity 96.7% and 59.9%, respectively.

CONCLUSION

US or abdominal X-ray in children with possible appendicitis should be integrated with PAS to determine the next steps in management. In the case of discordance between the clinical findings and radiology, prolonged observation or further imaging are recommended.

摘要

背景

超声检查（US）和腹部X线检查联合小儿阑尾炎评分（PAS）在急性阑尾炎诊断中的效能较为复杂。在急性阑尾炎诊断中，当由经验丰富的儿科放射科医生评估时，腹部X线检查与超声检查在临床评估方面同样有用。本研究的目的是确定超声检查和腹部X线检查在结合基于PAS的临床评估时对儿童阑尾炎的诊断价值，并建立一条针对儿童急性阑尾炎的实用诊断路径。

方法

在一家城市学术性儿科急诊科进行了一项前瞻性观察队列研究。患者被分为阑尾炎低风险（PAS 1 - 4）、中度风险（PAS 5 - 7）或高风险（PAS 8 - 10）。低风险患者在≤10天内通过电话随访出院；中度风险患者接受X线和超声检查。高风险患者立即接受外科会诊。根据组织病理学结果将患者分为确诊急性阑尾炎或无阑尾炎。

结果

共分析了288名儿童。134例患者（46.5%）接受了手术，其中128例（95.5%）组织病理学检查呈阳性。有阑尾炎和无阑尾炎患者的平均PAS分别为7.09±1.42和4.97±2.29（P = 0.00）。漏诊率为6/288（2%），阴性阑尾切除率为6/134（4.4%）。当评分临界值设定为6时，PAS的敏感性和特异性分别为86.7%和63.1%。日间超声检查的诊断效能敏感性为91.1%，特异性为71.1%。此外，超声检查阳性或PAS>6或两者均阳性时，敏感性和特异性分别为96.7%和59.9%。