Integration of radiology and clinical score in pediatric appendicitis

dc.contributor.authorAydin, Derya
dc.contributor.authorTuran, Caner
dc.contributor.authorYurtseven, Ali
dc.contributor.authorBayindir, Petek
dc.contributor.authorToker, Bade
dc.contributor.authorDokumcu, Zafer
dc.contributor.authorSezak, Murat
dc.contributor.authorSaz, Eylem Ulas
dc.date.accessioned2019-10-27T10:43:01Z
dc.date.available2019-10-27T10:43:01Z
dc.date.issued2018
dc.departmentEge Üniversitesien_US
dc.description2nd European Pediatric Resuscitattion and Emergency Medicine Conference -- MAY 18-19, 2017 -- Gent, BELGIUMen_US
dc.description.abstractBackgroundThe efficacy of ultrasonography (US) and abdominal X-ray in combination with Pediatric Appendicitis Score (PAS) is complicated in the diagnosis of acute appendicitis. Abdominal X-ray is as useful as US with clinical assessment when evaluated by experienced pediatric radiologist in acute appendicitis. The aim of this study was to determine the value of US and abdominal X-ray for appendicitis in children when combined with clinical assessment based on PAS, and to establish a practical pathway for acute appendicitis in childhood. MethodsA prospective, observational cohort study was conducted at an urban, academic pediatric emergency department. Patients were classified at low (PAS 1-4), intermediate (PAS 5-7), or high (PAS 8-10) risk for appendicitis. Low-risk patients were discharged with telephone follow-up in 10days; those at intermediate risk underwent X-ray and US. High-risk patients received immediate surgical consultation. Patients were grouped on histopathology as having either proven acute appendicitis or no appendicitis. ResultsA total of 288 children were analyzed. Surgery was performed in 134 patients (46.5%), and 128 (95.5%) had positive histopathology. Mean PAS in the patients with and without appendicitis was 7.091.42 and 4.97 +/- 2.29, respectively (P=0.00). The rate of missed cases was 6/288 (2%), and the negative appendectomy rate was 6/134 (4.4%). When the score cut-off was set at 6, the sensitivity and specificity of PAS was 86.7% and 63.1%, respectively. The diagnostic performance of daytime US had a sensitivity of 91.1% and specificity of 71.1%. Also, positive US or PAS >6 or both, had sensitivity and specificity 96.7% and 59.9%, respectively. ConclusionUS or abdominal X-ray in children with possible appendicitis should be integrated with PAS to determine the next steps in management. In the case of discordance between the clinical findings and radiology, prolonged observation or further imaging are recommended.en_US
dc.identifier.doi10.1111/ped.13471en_US
dc.identifier.endpage178en_US
dc.identifier.issn1328-8067
dc.identifier.issn1442-200X
dc.identifier.issue2en_US
dc.identifier.pmid29205688en_US
dc.identifier.scopusqualityQ3en_US
dc.identifier.startpage173en_US
dc.identifier.urihttps://doi.org/10.1111/ped.13471
dc.identifier.urihttps://hdl.handle.net/11454/30714
dc.identifier.volume60en_US
dc.identifier.wosWOS:000426076600013en_US
dc.identifier.wosqualityQ4en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherWileyen_US
dc.relation.ispartofPediatrics Internationalen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectappendicitisen_US
dc.subjectchildrenen_US
dc.subjectclinical scoreen_US
dc.subjectradiologyen_US
dc.titleIntegration of radiology and clinical score in pediatric appendicitisen_US
dc.typeArticleen_US

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