Williamson Kristy, Sherman Joshua M, Fishbein Joanna Stein, Rocker Joshua
From the Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, NY.
Children's Hospital Los Angeles, Los Angeles, CA.
Pediatr Emerg Care. 2021 Aug 1;37(8):e456-e460. doi: 10.1097/PEC.0000000000001672.
Oftentimes while pursing the diagnosis of appendicitis, an ultrasound cannot visualize the appendix, and physicians must utilize other resources for evaluation. The primary objective of this study was to determine if there was a lower rate of appendicitis when the appendix was not visualized on ultrasound. Furthermore, we assessed the importance of specific clinical predictors in this population.
We conducted a retrospective chart review of all children who presented to our pediatric emergency department from 2011 to 2013 and had an abdominal ultrasound. We identified total numbers of ultrasounds with a nonvisualized appendix and then assessed follow-up for a randomly selected group of patients. We performed logistic regression to assess the predictive value of different clinical factors.
A total of 3245 ultrasounds were analyzed, and in 54% of these, the appendix was nonvisualized. In total, 28% of the total patients and 11.9% of patients who received a nonvisualized ultrasound had appendicitis (95% confidence interval [CI], 8.3%-16.2%). Among those patients who had follow-up studies performed during the same visit, 21.2% had appendicitis (95% CI, 14.9%-28.8%), and of those discharged without a diagnosis, 1.5% had appendicitis (95% CI, 0.2%-5.4%). Male sex, leukocytosis, and an elevated absolute neutrophil count were each significantly associated with appendicitis after a nonvisualized appendix on ultrasound.
A significant proportion of patients with suspected appendicitis who had an initial nonvisualized appendix on ultrasound were ultimately diagnosed with appendicitis. Clinicians must be vigilant about pursuing a definitive diagnosis if an initial ultrasound is nondiagnostic.
在寻求阑尾炎诊断时，超声常常无法显示阑尾，医生必须利用其他资源进行评估。本研究的主要目的是确定超声未显示阑尾时阑尾炎的发生率是否较低。此外，我们评估了该人群中特定临床预测因素的重要性。
我们对2011年至2013年到我院儿科急诊科就诊并接受腹部超声检查的所有儿童进行了回顾性病历审查。我们确定了阑尾未显示的超声检查总数，然后对一组随机选择的患者进行随访评估。我们进行逻辑回归分析以评估不同临床因素的预测价值。
共分析了3245次超声检查，其中54%的检查阑尾未显示。在所有患者中，28%被诊断为阑尾炎，在阑尾未显示的超声检查患者中，11.9%被诊断为阑尾炎（95%置信区间[CI]，8.3%-16.2%）。在同一就诊期间进行了后续检查的患者中，21.2%被诊断为阑尾炎（95%CI，14.9%-28.8%），在未确诊就出院的患者中，1.5%被诊断为阑尾炎（95%CI，0.2%-5.4%）。男性、白细胞增多和绝对中性粒细胞计数升高在超声检查阑尾未显示后均与阑尾炎显著相关。
相当一部分疑似阑尾炎且初始超声检查未显示阑尾的患者最终被诊断为阑尾炎。如果初始超声检查无法确诊，临床医生必须警惕进行明确诊断。
