Soundappan Soundappan Sv, Karpelowsky Jonathan, Lam Albert, Lam Lawrence, Cass Danny
Department of Surgery, The Children's Hospital at Westmead, Sydney, Sydney Medical School, University of Sydney, Australia.
Department of Surgery, The Children's Hospital at Westmead, Sydney, Sydney Medical School, University of Sydney, Australia.
J Pediatr Surg. 2018 Oct;53(10):2023-2027. doi: 10.1016/j.jpedsurg.2018.05.014. Epub 2018 May 23.
Compare the diagnostic accuracy of surgeon performed ultrasound to radiology performed ultrasound in children presenting with suspected appendicitis to a tertiary care pediatric hospital in Australia.
Children under 16 presenting to the emergency department of The Children's Hospital at Westmead were considered for the study. Patients with obvious signs of appendicitis not requiring ultrasound and those with established ultrasound diagnosis of appendicitis were excluded. Ultrasound was performed by a Pediatric Surgeon (SPU) after obtaining consent. The treating team was blinded to the results. Patient underwent formal ultrasound in radiology (RPU) and treatment was based on the formal report. SPU result was reviewed by a radiologist blinded to results of RPU. The results were compared.
65 children underwent ultrasound. 35 were male. Median age was 10 (range3-15). Median weight was 36 kg (range 12.6-76.2 kg), z-score median 0.21 (-1.83 to 2.74). Symptom duration ranged from few hours to 2 weeks but majority (45) had symptoms for less than 48 h. Prevalence of appendicitis was 45%. Thirty two underwent surgery. Negative appendicectomy rate was 9.4%. Thirty three did not have surgery. 8 represented but only one proceeded to appendicectomy. SPU was done earlier than RPU (median 12 h vs 14.15 h) p = 0.088. Diagnostic accuracy using ROC did not reveal significant difference.
SPU can be performed earlier than RPU with reliable accuracy. Training surgical trainees will enable early diagnosis and management of appendicitis.
比较在澳大利亚一家三级医疗儿科医院中，外科医生进行的超声检查与放射科医生进行的超声检查对疑似阑尾炎儿童的诊断准确性。
考虑纳入向韦斯特米德儿童医院急诊科就诊的16岁以下儿童进行研究。排除有明显阑尾炎体征无需超声检查的患者以及已通过超声确诊阑尾炎的患者。在获得同意后，由一名儿科外科医生进行超声检查（SPU）。治疗团队对检查结果不知情。患者在放射科接受正式超声检查（RPU），治疗依据正式报告进行。由一名对RPU结果不知情的放射科医生复查SPU结果。对结果进行比较。
65名儿童接受了超声检查。35名男性。中位年龄为10岁（范围3 - 15岁）。中位体重为36千克（范围12.6 - 76.2千克），z评分中位数为0.21（-1.83至2.74）。症状持续时间从数小时至2周不等，但大多数（45名）症状持续时间少于48小时。阑尾炎患病率为45%。32名患者接受了手术。阴性阑尾切除率为9.4%。33名患者未进行手术。8名患者有相关表现，但只有1名进行了阑尾切除术。SPU比RPU完成得更早（中位时间12小时对14.15小时），p = 0.088。使用ROC曲线分析诊断准确性未显示出显著差异。
SPU可以比RPU更早进行，且准确性可靠。培训外科住院医师将有助于阑尾炎的早期诊断和治疗。
