Reddan Tristan, Corness Jonathan, Harden Fiona, Mengersen Kerrie
Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia.
Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia.
J Med Radiat Sci. 2018 Dec;65(4):267-274. doi: 10.1002/jmrs.310. Epub 2018 Oct 28.
The objectives of this study were to identify knowledge gaps and/or perceived limitations in the performance of paediatric appendiceal ultrasound by Australasian sonographers. We hypothesised that: sonographers' confidence in visualising the appendix in children was poor, particularly outside predominantly paediatric practice; workplace support for prolonging examinations to improve visualisation was limited; and the sonographic criteria applied in diagnosis did not reflect contemporary literature.
A cross-sectional survey of Australasian sonographers regarding paediatric appendicitis was conducted using a mixed methods approach (quantitative and qualitative data). Text responses were analysed for key themes, and quantitative data analysed using chi-square, Mann-Whitney U and Wilcoxon signed-rank tests.
Of the 124 respondents, 27 (21.8%) reported a visualisation rate of less than 10%. Workplace support for extending examination time was significantly related to a higher appendix visualisation rate (χ (2) = 16.839, P < 0.001). Text responses reported frustration locating the appendix and a desire for more time and practice to improve visualisation. Sonographers suggested a significantly lower maximum diameter cut-off in a 5-year-old compared to a 13-year-old (Z = -6.07, P < 0.001), and considered the presence of inflamed peri-appendiceal mesentery as the most useful sonographic criterion in diagnosing acute appendicitis.
Respondents had a low opinion of their ability to confidently identify the appendix. Confidence was greater in those centres where extending scanning time was encouraged. Application of echogenic mesentery as the most significant secondary sonographic criterion is supported by recent studies. Opinions of diameter cut-offs varied, indicating potential for improved awareness of recent research.
本研究的目的是确定澳大利亚超声检查医师在小儿阑尾超声检查操作中存在的知识空白和/或认知局限。我们假设：超声检查医师对儿童阑尾可视化的信心不足，尤其是在主要为成人的超声检查实践之外；延长检查时间以改善可视化的工作场所支持有限；诊断中应用的超声标准未反映当代文献。
采用混合方法（定量和定性数据）对澳大利亚超声检查医师进行关于小儿阑尾炎的横断面调查。对文本回复进行关键主题分析，定量数据采用卡方检验、曼-惠特尼U检验和威尔科克森符号秩检验进行分析。
在124名受访者中，27人（21.8%）报告可视化率低于10%。延长检查时间的工作场所支持与较高的阑尾可视化率显著相关（χ(2)=16.839，P<0.001）。文本回复报告了定位阑尾的挫败感以及希望有更多时间和实践来改善可视化。超声检查医师建议5岁儿童的最大直径截断值明显低于13岁儿童（Z=-6.07，P<0.001），并认为阑尾周围肠系膜发炎是诊断急性阑尾炎最有用的超声标准。
受访者对自己自信识别阑尾的能力评价较低。在鼓励延长扫描时间的中心，信心更强。近期研究支持将高回声肠系膜作为最重要的二级超声标准。直径截断值的观点各不相同，表明提高对最新研究的认识具有潜力。
