Farrell Crystal R, Bezinque Adam D, Tucker Jared M, Michiels Erica A, Betz Bradford W
Grand Rapids Medical Education Partners, Grand Rapids, MI, USA.
Michigan State University College of Human Medicine, Grand Rapids, MI, USA.
Emerg Radiol. 2018 Jun;25(3):257-263. doi: 10.1007/s10140-017-1574-7. Epub 2018 Jan 6.
We compared the diagnostic accuracy of CT performed without and with oral contrast for suspected appendicitis in children.
In this retrospective cohort study, we reviewed abdomen/pelvis CT scans with IV contrast performed between 2011 and 2015 for suspected appendicitis. Oral contrast was used routinely before August 2013 and eliminated from the CT protocol thereafter. Diagnostic accuracy of CT was compared with operative/pathology reports, and included a 30-day follow-up period for non-surgical patients. For a secondary analysis, the oral contrast group was subdivided into "complete" (contrast extending into the cecum) or "partial" contrast. We also compared groups for CT turnaround time, the frequency of appendiceal perforation and abscess, and the potential influence of a prior appendix ultrasound.
Five hundred fifty-eight patients were included: 51.6% (n = 288) without oral contrast and 48.4% (n = 270) with oral contrast (of which 52% (n = 140/270) had "complete" contrast). There was no difference in diagnostic accuracy between the oral contrast and non-contrast groups (p = 0.903), with sensitivity/specificity of 93.8% (95% CI 84.8-98.3)/98.5% (CI 95.8-99.7) and 94.6% (CI 84.9-98.9)/98.3% (CI 95.7-99.5), respectively. Similarly, there was no difference in accuracy when comparing only "complete" contrast vs. non-contrast groups (p = 0.755). CT turnaround time for the non-contrast group was significantly faster (43.8 ± 37.6 min), on average, than the oral contrast group (137.4 ± 47.5 min).
For children evaluated by CT with IV contrast for suspected appendicitis, administering oral contrast increased wait time by > 90 min, did not reach the cecum in 48% of cases, and did not improve diagnostic accuracy. Oral contrast for pediatric CT appendicitis evaluation is not warranted.
我们比较了在怀疑小儿阑尾炎时，行CT检查时口服对比剂与否的诊断准确性。
在这项回顾性队列研究中，我们回顾了2011年至2015年间因怀疑阑尾炎而行静脉注射对比剂的腹部/盆腔CT扫描。2013年8月之前常规使用口服对比剂，此后从CT检查方案中取消。将CT的诊断准确性与手术/病理报告进行比较，对非手术患者进行为期30天的随访。作为一项次要分析，口服对比剂组被细分为“完全”（对比剂延伸至盲肠）或“部分”对比剂。我们还比较了各组的CT检查周转时间、阑尾穿孔和脓肿的发生率，以及先前阑尾超声检查的潜在影响。
共纳入558例患者：51.6%（n = 288）未使用口服对比剂，48.4%（n = 270）使用口服对比剂（其中52%（n = 140/270）为“完全”对比剂）。口服对比剂组和未使用对比剂组之间的诊断准确性无差异（p = 0.903），敏感性/特异性分别为93.8%（95%CI 84.8 - 98.3）/98.5%（CI 95.8 - 99.7）和94.6%（CI 84.9 - 98.9）/98.3%（CI 95.7 - 99.5）。同样，仅比较“完全”对比剂组与未使用对比剂组时，准确性也无差异（p = 0.755）。未使用对比剂组的CT检查周转时间平均（43.8 ± 37.6分钟）明显快于口服对比剂组（137.4 ± 47.5分钟）。
对于因怀疑阑尾炎而行静脉注射对比剂CT检查的儿童，使用口服对比剂会使等待时间增加超过90分钟，48%的病例中对比剂未到达盲肠，且未提高诊断准确性。小儿CT阑尾炎评估中无需使用口服对比剂。
