Dessie Almaz S, Kwok Maria, Mills Lisa, Sivitz Adam, Elkhunovich Marsha, Nti Benjamin, Constantine Erika, Bergmann Kelly, Ekpenyong Atim, Toney Amanda, Li Xiaoyang, Dayan Peter S, Kessler David
Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Columbia University Vagelos College of Physicians & Surgeons, New York, New York, USA.
J Ultrasound Med. 2025 Aug;44(8):1473-1480. doi: 10.1002/jum.16702. Epub 2025 Apr 9.
Acute appendicitis is a common surgical emergency in children. Prior radiology studies have described Puylaert staging on ultrasound to determine the severity of appendicitis. We investigated the feasibility and utility of assessing Puylaert staging on emergency department (ED) point-of-care ultrasound (POCUS) to differentiate uncomplicated from complicated appendicitis in children.
This was a pilot feasibility study of children ages 5-17 diagnosed with acute appendicitis in nine pediatric EDs. POCUS was performed by trained ED physicians. Puylaert staging of the submucosal layer was used to categorize the severity of appendicitis (stages 1-4) and was compared with surgical pathology reports. Test characteristics were computed to evaluate the accuracy of POCUS in differentiating appendicitis severity. Physicians recorded time to complete POCUS, ease of use, and their perception of acceptability by patients and families.
Of 72 patients with complete data, all patients with uncomplicated appendicitis were accurately identified using POCUS (Puylaert stage 1 or 2). The sensitivity for identifying complicated appendicitis (Puylaert Stage 3 or 4) was 100% (95% CI: 77%-100%), and specificity was 65% (95% CI: 52%-78%). Ninety four percent of physicians agreed that the POCUS was easy to perform. One hundred percent agreed that it was well accepted by families. The average time to complete POCUS was 8 min.
This study supports the feasibility and utility of assessing Puylaert staging by POCUS for children with appendicitis in the ED. High sensitivity to rule out complicated cases coupled with ease of use and perceived patient acceptance make this a potential adjunct to aid in the management of pediatric appendicitis.
急性阑尾炎是儿童常见的外科急症。既往影像学研究描述了超声下的普伊拉特分期以确定阑尾炎的严重程度。我们调查了在急诊科（ED）使用即时超声（POCUS）评估普伊拉特分期以鉴别儿童单纯性阑尾炎与复杂性阑尾炎的可行性和实用性。
这是一项针对9个儿科急诊科中5至17岁诊断为急性阑尾炎儿童的初步可行性研究。POCUS由经过培训的急诊科医生进行操作。采用黏膜下层的普伊拉特分期对阑尾炎的严重程度进行分类（1至4期），并与手术病理报告进行比较。计算检验特征以评估POCUS鉴别阑尾炎严重程度的准确性。医生记录完成POCUS的时间、易用性以及他们对患者及其家属可接受性的看法。
在72例有完整数据的患者中，所有单纯性阑尾炎患者均通过POCUS准确识别（普伊拉特1期或2期）。识别复杂性阑尾炎（普伊拉特3期或4期）的敏感性为100%（95%CI：77% - 100%），特异性为65%（95%CI：52% - 78%）。94%的医生认为POCUS易于操作。100%的医生认为其被家属广泛接受。完成POCUS的平均时间为8分钟。
本研究支持在急诊科对阑尾炎患儿通过POCUS评估普伊拉特分期的可行性和实用性。对排除复杂病例的高敏感性、易用性以及患者的可接受性使其成为辅助管理小儿阑尾炎的潜在手段。
