Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Pediatric Surgery, Children's Health, Dallas, Texas.
J Surg Res. 2019 Aug;240:97-103. doi: 10.1016/j.jss.2019.02.047. Epub 2019 Mar 25.
Diagnostic imaging in pediatric appendicitis may decrease rates of negative appendectomy and identify alternate pathologies. We compared imaging practices for children transferred from nonpediatric facilities versus directly admitted to our tertiary children's hospital for laparoscopic appendectomy, and assessed the diagnostic accuracy in each population based on final pathologic diagnosis.
After institutional review board approval, all cases of laparoscopic appendectomy at our children's hospital during 2015 were reviewed. Demographic and clinical data were collected, including age, transfer status, imaging studies, and pathologic diagnosis. Imaging practices in patients transferred from adult centers were compared with those directly admitted.
There were 1153 included patients who underwent laparoscopic appendectomy for acute appendicitis during the study period, with 242 (20.9%) presenting as transfers from nonpediatric facilities. Of these, 73.5% underwent preoperative computed tomography (CT), compared with 26.4% of nontransfer patients (P < 0.000). All remaining patients received ultrasound (US). Despite variation in imaging strategies, rates of negative appendectomy were similar in transfer and nontransfer groups (1.7% versus 2.0%, respectively, P = 0.744). There were marginal differences in sensitivity of US and CT to detect appendix features between the transferring and referral centers.
Our results show that nonpediatric facilities use CT more frequently to diagnose pediatric appendicitis. Rates of nontherapeutic surgery were equivalent between transferred and directly admitted patients, which is likely related to high performance of both imaging strategies. Transferring centers should strive to rely more heavily on US, which may require education and development of improved pediatric US capacity.
儿科阑尾炎的诊断影像学检查可降低阴性阑尾切除术的发生率，并可识别其他病理改变。我们比较了从非儿科医疗机构转来的儿童与直接转入我们三级儿童医院行腹腔镜阑尾切除术的患儿的影像学检查方法，并根据最终病理诊断评估了两种人群的诊断准确性。
在机构审查委员会批准后，我们回顾了我院 2015 年所有腹腔镜阑尾切除术病例。收集了人口统计学和临床数据，包括年龄、转院状态、影像学检查和病理诊断。比较了从成人中心转来的患者和直接入院的患者的影像学检查方法。
在研究期间，有 1153 例患者因急性阑尾炎接受了腹腔镜阑尾切除术，其中 242 例（20.9%）来自非儿科医疗机构。其中，73.5%的患者接受了术前计算机断层扫描（CT），而非转院患者为 26.4%（P<0.000）。其余所有患者均接受了超声（US）检查。尽管影像学检查策略存在差异，但转院组和非转院组的阴性阑尾切除术发生率相似（分别为 1.7%和 2.0%，P=0.744）。转诊中心和转院中心之间，US 和 CT 检测阑尾特征的敏感性存在差异。
我们的结果表明，非儿科医疗机构更常使用 CT 来诊断小儿阑尾炎。转院组和直接入院组的非治疗性手术率相当，这可能与两种影像学检查策略的高表现相关。转诊中心应努力更多地依赖 US，这可能需要教育和发展更好的儿科 US 能力。
