Division of Emergency Medicine, Boston Children's Hospital, BCH 3066, 300 Longwood Ave., Boston, MA, 02115, USA.
Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
Pediatr Radiol. 2021 Oct;51(11):2018-2026. doi: 10.1007/s00247-021-05100-0. Epub 2021 May 27.
Secondary sonographic findings of appendicitis can aid image analysis and support diagnosis with and without visualization of an appendix.
We sought to determine if age affected the test performance of secondary findings for pediatric appendicitis.
We performed a medical record review of emergency department patients younger than 19 years of age who had a sonogram for suspected appendicitis. Our primary patient outcome was appendicitis, as determined by pathology or by image-confirmed perforation/abscess. Our primary analysis was test performance of secondary sonographic findings as recorded by sonographers on the final diagnosis of appendicitis stratified by age (<6 years, 6 to <11 years, 11 to <19 years).
A total of 1,219 patients with suspected appendicitis were evaluated by ultrasound, and 1,147 patients met the criteria for analysis. Of the 1,147 patients, 431 (37.6%) had a final diagnosis of appendicitis. Across all age groups, echogenic fat was the most accurate secondary finding (92.5% [95% confidence interval (CI): 91.0, 94.0]) and free fluid was the least accurate secondary finding (54.7% [95% CI: 51.8, 57.5]). There was no significant difference in the age-stratified test performance of secondary sonographic findings except that (1) appendicolith was a more accurate predictor in patients <6 years old than in the middle group (P<0.001) or the oldest group (P<0.001), and (2) free fluid was a more accurate predictor in the middle group than in the oldest group (P=0.02).
There are no significant differences in the age-stratified test performance of secondary sonographic findings in the prediction of pediatric appendicitis except that appendicolith is more predictive in younger patients.
阑尾炎的次要超声表现可以辅助影像分析，并在阑尾显影或不显影的情况下支持诊断。
我们旨在确定年龄是否影响小儿阑尾炎次要表现的检测性能。
我们对因疑似阑尾炎而行超声检查的 19 岁以下急诊科患者进行了病历回顾。我们的主要患者结局是通过病理或通过影像学证实穿孔/脓肿来确定的阑尾炎。我们的主要分析是对超声医师记录的次要超声表现进行分析，这些表现是根据最终阑尾炎诊断进行分层的，分为<6 岁、6 至<11 岁、11 至<19 岁。
共有 1219 例疑似阑尾炎患者接受了超声检查，其中 1147 例符合分析标准。在 1147 例患者中，431 例（37.6%）的最终诊断为阑尾炎。在所有年龄组中，回声增强的脂肪是最准确的次要发现（92.5%[95%可信区间：91.0，94.0]），而游离液体是最不准确的次要发现（54.7%[95%可信区间：51.8，57.5]）。除以下两种情况外，各年龄组的次要超声表现的检测性能无显著差异：（1）在<6 岁的患者中，阑尾结石比在中间组或最大年龄组更能准确预测（P<0.001）；（2）在中间组中，游离液体比最大年龄组更能准确预测（P=0.02）。
除了阑尾结石在年幼患者中更具预测性之外，在预测小儿阑尾炎方面，次要超声表现的检测性能在各年龄组之间没有显著差异。
