Department of Surgery, St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105, USA.
Department of Pediatric Surgery, Hospital Universitario Virgen Del Rocio, Sevilla, Spain.
J Pediatr Surg. 2021 Aug;56(8):1356-1361. doi: 10.1016/j.jpedsurg.2020.09.061. Epub 2020 Nov 4.
Appendicitis in children can be diagnosed utilizing clinical and laboratory findings, with the assistance of ultrasound (US) and/or computed tomography (CT). However, repeated exposure to ionizing radiation increases the lifetime risk of cancer. We compared the work-up of suspected appendicitis between a children's hospital in the United States (USA) and one in Spain to identify differences in imaging use and associated outcomes.
A two-institution retrospective review was performed for surgical consultations of suspected appendicitis from 2015-2017. We compared imaging use, the utilization of overnight observation, and diagnostic accuracy rates between the two centers.
A total of 1,952 children were evaluated. Among the 1,288 in the USA center, 754(58.5%) underwent CT during their evaluation. The most common imaging modality was US only (39.9%), then CT only (39.3%), CT+US (19.3%), and no imaging (i.e. only clinical acumen) (1.6%). In Spain, only 19 (2.9%) of 664 children underwent CT compared to the USA (p < 0.0001). Only clinical acumen was the most common modality employed (48.6%), followed by US only (48.5%), US+CT (2.4%), and CT only (0.5%). In the USA, 16.8% were observed overnight, 2.3% of whom received no imaging. In Spain, 33.4% were observed overnight, 32.4% of whom had no imaging (p < 0.0001). The accuracy rates for diagnosing appendicitis in the USA and Spain centers were 94.7% and 95.1%, respectively.
Use of clinical acumen and/or US have similar clinical outcomes and similar accuracy rates compared to heavy reliance on CT imaging for diagnosing appendicitis, with associated decrease in radiation exposure. The disparate diagnostic approach of the two centers may reflect that physical examination is a dying art in North America.
III.
儿童阑尾炎可通过临床和实验室检查，结合超声（US）和/或计算机断层扫描（CT）进行诊断。然而，反复接受电离辐射会增加终生患癌症的风险。我们比较了美国一家儿童医院和西班牙一家儿童医院对疑似阑尾炎的检查，以确定影像学使用和相关结果的差异。
对 2015 年至 2017 年期间进行的疑似阑尾炎手术咨询进行了两机构回顾性研究。我们比较了两个中心的影像学使用、过夜观察的利用情况和诊断准确率。
共评估了 1952 名儿童。在美国中心的 1288 名儿童中，754 名（58.5%）在评估期间接受了 CT 检查。最常见的影像学方式是仅行 US（39.9%），其次是仅行 CT（39.3%）、CT+US（19.3%）和无影像学检查（即仅依靠临床判断）（1.6%）。在西班牙，仅 19 名（2.9%）664 名儿童接受了 CT 检查，而美国则为 754 名（p < 0.0001）。仅行临床判断是最常用的影像学方式（48.6%），其次是仅行 US（48.5%）、US+CT（2.4%）和仅行 CT（0.5%）。在美国，16.8%的患者接受了过夜观察，其中 2.3%的患者未接受影像学检查。在西班牙，33.4%的患者接受了过夜观察，其中 32.4%的患者未接受影像学检查（p < 0.0001）。美国和西班牙中心诊断阑尾炎的准确率分别为 94.7%和 95.1%。
与重度依赖 CT 成像诊断阑尾炎相比，仅凭临床判断和/或 US 进行诊断具有相似的临床结局和相似的准确率，同时可降低辐射暴露。两个中心不同的诊断方法可能反映出北美体格检查正逐渐成为一门消亡的艺术。
III 级
