Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Emerg Med J. 2022 Dec;39(12):924-930. doi: 10.1136/emermed-2021-211751. Epub 2022 Mar 7.
Appendiceal diameter is a primary sonographic determinant of paediatric appendicitis. We sought to determine if the diagnostic performance of outer appendiceal diameter differs based on age or with the addition of secondary sonographic findings.
We retrospectively reviewed patients aged less than 19 years who presented to the Boston Children's Hospital ED and had an ultrasound (US) for the evaluation of appendicitis between November 2015 and October 2018. Our primary outcome was the presence of appendicitis. We analysed the cases to evaluate the optimal outer appendiceal diameter as a predictor for appendicitis stratified by age (<6, 6 to <11, 11 to <19 years), and with the addition of one or more secondary sonographic findings.
Overall, 945 patients met criteria for inclusion, of which 43.9% had appendicitis. Overall, appendiceal diameter as a continuous measure demonstrated excellent test performance across all age groups (area under the curve (AUC) >0.95) but was most predictive of appendicitis in the youngest age group (AUC=0.99 (0.98-1.00)). Although there was no significant difference in optimal diameter threshold between age groups, both 7- and 8-mm thresholds were more predictive than 6 mm across all groups (p<0.001). The addition of individual (particularly appendicolith or echogenic fat) or combinations of secondary sonographic findings increased the diagnostic value for appendicitis above diameter alone.
Appendiceal diameter as a continuous measure was more predictive of appendicitis in the youngest group. Across all age groups, the optimal diameter threshold was 7 mm for the diagnosis of paediatric appendicitis. The addition of individual or combination secondary sonographic findings increases diagnostic performance.
阑尾直径是小儿阑尾炎的主要超声学决定因素。我们旨在确定阑尾外径的诊断性能是否因年龄而异，或者是否随着次要超声表现的增加而有所不同。
我们回顾性分析了 2015 年 11 月至 2018 年 10 月期间在波士顿儿童医院急诊科就诊并接受超声（US）检查以评估阑尾炎的年龄小于 19 岁的患者。我们的主要结局是存在阑尾炎。我们分析了这些病例，以评估根据年龄（<6、6 至<11、11 至<19 岁）分层的阑尾外径作为阑尾炎预测因子的最佳值，并结合了一个或多个次要超声表现。
总体而言，945 例患者符合纳入标准，其中 43.9%患有阑尾炎。总体而言，阑尾直径作为连续测量指标在所有年龄组中均表现出出色的测试性能（曲线下面积（AUC）>0.95），但在年龄最小的年龄组中最能预测阑尾炎（AUC=0.99（0.98-1.00））。尽管各年龄组之间最佳直径阈值没有显着差异，但在所有组中，7-和 8-mm 阈值均比 6-mm 更具预测性（p<0.001）。单独（特别是阑尾结石或回声脂肪）或组合的次要超声表现的增加增加了阑尾单独直径的诊断价值。
作为连续测量指标，阑尾直径在年龄最小的组中对阑尾炎的预测性更高。在所有年龄组中，最佳直径阈值为 7 毫米，可诊断小儿阑尾炎。单独或组合使用次要超声表现可提高诊断性能。
