Shieh Andrew, Pham Phung K, Plouffe Nicole A, Heyming Theodore W
Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics, University of California at Irvine, Irvine, California.
Children's Hospital Los Angeles, Los Angeles, California; Claremont Graduate University, Claremont, California.
J Emerg Med. 2023 Mar;64(3):304-310. doi: 10.1016/j.jemermed.2022.12.018. Epub 2023 Mar 1.
Although appendicitis is the most common pediatric surgical emergency, the path to diagnosis remains equivocal, with utilization of imaging modalities largely institution dependent.
Our objective was to compare imaging practices and negative appendectomy rates between patients transferred from nonpediatric hospitals to our pediatric hospital and primary patients presenting directly to our institution.
We retrospectively reviewed all laparoscopic appendectomy cases performed at our pediatric hospital in 2017 for imaging and histopathologic results. Two-sample z-test was used to examine negative appendectomy rates between transfer and primary patients. The negative appendectomy rates of patients who received different imaging modalities were analyzed using the Fisher's exact test.
Of 626 patients, 321 (51%) were transferred from nonpediatric hospitals. The negative appendectomy rate for transfer patients was 6.5% and 6.6% for primary patients (p = 0.99). Ultrasound (US) was the only imaging obtained in 31% of transfer and 82% of primary patients. The negative appendectomy rate of US performed at transfer hospitals compared with our pediatric institution was not significantly different (11% vs. 5%, p = 0.06). Computed tomography (CT) was the only imaging obtained in 34% of transfer and 5% of primary patients. Both US and CT were completed for 17% of transfer and 19% of primary patients.
The negative appendectomy rates of transfer and primary patients were not significantly different despite more frequent CT use at nonpediatric facilities. It may be valuable to encourage US utilization at adult facilities given the potential to safely reduce CT use in the evaluation of suspected pediatric appendicitis.
尽管阑尾炎是最常见的儿科外科急症，但诊断路径仍不明确，成像方式的使用在很大程度上取决于医疗机构。
我们的目的是比较从非儿科医院转至我院的患儿与直接到我院就诊的初诊患儿的成像检查情况及阴性阑尾切除术的发生率。
我们回顾性分析了2017年在我院接受腹腔镜阑尾切除术的所有病例的成像检查及组织病理学结果。采用双样本z检验比较转院患儿和初诊患儿的阴性阑尾切除术发生率。使用Fisher精确检验分析接受不同成像检查方式的患儿的阴性阑尾切除术发生率。
在626例患者中，321例（51%）是从非儿科医院转来的。转院患儿的阴性阑尾切除术发生率为6.5%，初诊患儿为6.6%（p = 0.99）。31%的转院患儿和82%的初诊患儿仅接受了超声（US）检查。转院医院进行的超声检查与我院的阴性阑尾切除术发生率相比，差异无统计学意义（11%对5%，p = 0.06）。34%的转院患儿和5%的初诊患儿仅接受了计算机断层扫描（CT）检查。17%的转院患儿和19%的初诊患儿同时接受了超声和CT检查。
尽管非儿科医疗机构更频繁地使用CT，但转院患儿和初诊患儿的阴性阑尾切除术发生率差异无统计学意义。鉴于在疑似小儿阑尾炎评估中安全减少CT使用的可能性，鼓励成人医疗机构使用超声检查可能具有重要价值。
