Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Toronto, Toronto Canada; The Hospital for Sick Children Research Institute, University of Toronto, Toronto Canada.
Department Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto Canada.
Am J Emerg Med. 2023 Sep;71:217-224. doi: 10.1016/j.ajem.2023.06.026. Epub 2023 Jun 16.
to determine diagnostic accuracy of an US-MRI clinical diagnostic pathway to detect appendicitis in the emergency department (ED).
prospective cohort study of 624 previously healthy children 4-17 years old undergoing US for suspected appendicitis and clinical re-assessment. Children with non-diagnostic USs and persistent appendicitis concern/conclusive US-reassessment discrepancies underwent ultra-rapid MRI (US-MRI pathway), interpreted as positive, negative or non-diagnostic. Cases with missed appendicitis, negative appendectomies, and CT utilization were considered clinically diagnostically inaccurate. Primary outcome was the proportion of accurate diagnoses of appendicitis/lack thereof by the pathway.
150/624 (24%) children had appendicitis;255 USs (40.9%) were non-diagnostic. Of 139 US-MRI pathway children (after 117 non-diagnostic and 22 conclusive USs), 137 [98.6%; 95% CI 0.96-1.00] had clinically accurate outcomes (1 CT, 1 negative appendectomy): sensitivity 18/18 [100%], specificity 119/121 [98.3%], positive predictive value 18/20 [90.5%], negative predictive value 119/119 [100%]. MRI imaging accuracy was 134/139 (96.4%); 3 MRIs were non-diagnostic (no appendicitis). In the overall algorithm, 616/624 [98.7% (0.97-0.99)] patients had accurate outcomes: 147/150 (98.0%) appendicitis cases had confirmatory surgeries (3 CTs) and 469/474 (98.9%) appendicitis-negative children had no surgery/CT.
this study demonstrated high clinical accuracy of the US-rapid-MRI pathway in suspected pediatric appendicitis after non-diagnostic US.
确定超声-磁共振成像（US-MRI）临床诊断路径在急诊科（ED）诊断阑尾炎的诊断准确性。
对 624 例年龄在 4-17 岁、疑似阑尾炎且行 US 检查的既往健康儿童进行前瞻性队列研究，对 US 检查结果不明确且持续性阑尾炎可疑/US 检查结果不一致的儿童行超快速 MRI（US-MRI 路径）检查，结果为阳性、阴性或无法诊断。漏诊阑尾炎、阴性阑尾切除术和 CT 检查结果被认为是临床诊断不准确的病例。主要结局是该路径诊断阑尾炎的准确率。
150/624（24%）例儿童患有阑尾炎；255 次 US 检查（40.9%）结果不明确。139 例 US-MRI 路径患儿（117 例 US 检查结果不明确和 22 例 US 检查结果一致）中，137 例[98.6%；95%CI 0.96-1.00]临床诊断结果准确（1 例 CT，1 例阴性阑尾切除术）：敏感度 18/18[100%]，特异度 119/121[98.3%]，阳性预测值 18/20[90.5%]，阴性预测值 119/119[100%]。MRI 成像准确性为 134/139（96.4%）；3 例 MRI 结果无法诊断（无阑尾炎）。在整个算法中，616/624（98.7%（0.97-0.99））例患者的临床诊断结果准确：147/150（98.0%）例阑尾炎病例行确认性手术（3 例 CT），469/474（98.9%）例阑尾炎阴性儿童未行手术/CT。
本研究表明，在超声检查结果不明确的疑似小儿阑尾炎患者中，US-快速-MRI 路径具有较高的临床准确性。
