Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
J Am Coll Radiol. 2021 Aug;18(8):1128-1138. doi: 10.1016/j.jacr.2021.03.026. Epub 2021 Apr 30.
To determine if differences between individual sonographers and radiologists performing and interpreting appendix ultrasound affect clinically important outcomes in children with suspected acute appendicitis.
Patients <18 years of age who presented to our emergency department (ED) with suspected acute appendicitis and underwent an appendix ultrasound were identified. Sonographers who performed fewer than 100 examinations and radiologists who interpreted fewer than 100 examinations during the study period were excluded. Multivariable logistic regression was performed to assess the effect of sonographer, radiologist, clinical variables, and system factors on key clinical outcomes, including hospital admission and appendectomy.
In all, 9,283 appendix ultrasounds (mean age, 9.9 ± 4.2 years; 5,400 [58.2%] boys) performed by 31 sonographers (mean number of examinations, 299 ± 140 [range, 115-610]) and interpreted by 31 radiologists (mean number of examinations, 299 ± 157 [range, 101-845]) were included. Mean admission frequency per sonographer was 34.0% ± 3.3% (range, 27.8%-42.6%) and per radiologist was 33.5% ± 3.9% (range, 23.7%-41.6%). Mean appendectomy frequency per sonographer was 20.3% ± 2.6% (range, 14.9%-27.0%) and per radiologist was 20.3% ± 3.1% (range, 15.2%-28.7%). Significant multivariable predictors of hospital admission included temperature (P < .0001), white blood cell count (P < .0001), male sex (P = .002), imaging performed at the main hospital (versus satellite hospital) (P = .001), abdominal tenderness with ultrasound transducer compression (P < .0001), presence of rebound tenderness (P = .001), and presence of acute appendicitis by ultrasound (P < .0001), but not sonographer or radiologist. Predictors of appendectomy included weight (P < .0001), white blood cell count (P < .0001), male sex (P = .0004), abdominal tenderness with ultrasound transducer compression (P < .0001), and the presence of acute appendicitis by ultrasound (P < .0001), but not sonographer or radiologist.
Differences in individual sonographers and radiologists did not predict clinically important outcomes in children undergoing ultrasound in the ED for suspected acute appendicitis.
确定在对疑似急性阑尾炎的儿童进行阑尾超声检查时，执行和解释检查的个别超声医师和放射科医师之间的差异是否会对临床重要结局产生影响。
确定了在我院急诊科（ED）就诊并接受阑尾超声检查的<18 岁疑似急性阑尾炎的患者。排除了在研究期间进行的检查少于 100 次的超声医师和解释的检查少于 100 次的放射科医师。采用多变量逻辑回归评估超声医师、放射科医师、临床变量和系统因素对关键临床结局的影响，包括住院和阑尾切除术。
共纳入 9283 次阑尾超声检查（平均年龄 9.9 ± 4.2 岁；5400 [58.2%]名男孩），由 31 名超声医师（平均检查次数 299 ± 140 [范围，115-610]）和 31 名放射科医师（平均检查次数 299 ± 157 [范围，101-845]）进行检查。每位超声医师的平均住院率为 34.0%±3.3%（范围，27.8%-42.6%），每位放射科医师的平均住院率为 33.5%±3.9%（范围，23.7%-41.6%）。每位超声医师的平均阑尾切除率为 20.3%±2.6%（范围，14.9%-27.0%），每位放射科医师的平均阑尾切除率为 20.3%±3.1%（范围，15.2%-28.7%）。住院的显著多变量预测因素包括体温（P<0.0001）、白细胞计数（P<0.0001）、男性（P=0.002）、在主医院（而非卫星医院）进行的影像学检查（P=0.001）、超声检查时腹部压痛伴超声探头加压（P<0.0001）、存在反跳痛（P=0.001）和超声检查发现急性阑尾炎（P<0.0001），但超声医师和放射科医师不是预测因素。阑尾切除术的预测因素包括体重（P<0.0001）、白细胞计数（P<0.0001）、男性（P=0.0004）、超声检查时腹部压痛伴超声探头加压（P<0.0001）和超声检查发现急性阑尾炎（P<0.0001），但超声医师和放射科医师不是预测因素。
在急诊科对疑似急性阑尾炎的儿童进行超声检查时，个别超声医师和放射科医师之间的差异并不能预测临床重要结局。
