Sylvie Kaiser1, Håkan Jorulf, Erik Söderman, Björn Frenckner. 1. Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. sylvie.kaiser@kus.se
Abstract
RATIONALE AND OBJECTIVES: To evaluate how the surgeons' decision-making process in appendicitis in children is affected by radiologic imaging. MATERIALS AND METHODS: Prospective study including 593 children with suspected appendicitis was conducted. The surgeon's initial clinical disposition was recorded, designating the patient for operation, observation, or discharge. Thereafter, the patients were randomized to undergo either ultrasound only or ultrasound and abdominal computed tomography. The studies were evaluated by radiologists, who indicated if appendicitis was present or not. After radiology was completed, the surgeon re-examined the patient and made the final disposition. The change of disposition pathway was recorded. Final diagnoses were established by means of surgical, histopathologic, and/or clinical follow-up findings. RESULTS:Two hundred forty-four patients had appendicitis. The initial clinical disposition called for 88 operations, 338 observations, and 167 discharges. In total, 347 patients had their treatment plan changed from the initial disposition, resulting in 252 operations, 65 observations, and 276 discharges. In 11 patients, an unnecessary operation was possibly avoided. In 28 patients who turned out to have appendicitis, a possible inappropriate discharge was avoided. Eighteen patients had a false-negative radiologic diagnosis. Of these, 17 underwent surgery because of convincing clinical findings. The difference between the impact on surgeons' decision-making between the two randomized groups was not substantially different. The negative appendectomy rate was 3.7%. CONCLUSION:Radiologic imaging with ultrasound and/or computed tomography provides valuable guidance whether a patient should be discharged, observed, or given surgical treatment, leading to beneficial changes in management plan. Still, false-negative results may occur and a close clinical re-examination is of utmost importance for the appropriate final decision.
RCT Entities:
RATIONALE AND OBJECTIVES: To evaluate how the surgeons' decision-making process in appendicitis in children is affected by radiologic imaging. MATERIALS AND METHODS: Prospective study including 593 children with suspected appendicitis was conducted. The surgeon's initial clinical disposition was recorded, designating the patient for operation, observation, or discharge. Thereafter, the patients were randomized to undergo either ultrasound only or ultrasound and abdominal computed tomography. The studies were evaluated by radiologists, who indicated if appendicitis was present or not. After radiology was completed, the surgeon re-examined the patient and made the final disposition. The change of disposition pathway was recorded. Final diagnoses were established by means of surgical, histopathologic, and/or clinical follow-up findings. RESULTS: Two hundred forty-four patients had appendicitis. The initial clinical disposition called for 88 operations, 338 observations, and 167 discharges. In total, 347 patients had their treatment plan changed from the initial disposition, resulting in 252 operations, 65 observations, and 276 discharges. In 11 patients, an unnecessary operation was possibly avoided. In 28 patients who turned out to have appendicitis, a possible inappropriate discharge was avoided. Eighteen patients had a false-negative radiologic diagnosis. Of these, 17 underwent surgery because of convincing clinical findings. The difference between the impact on surgeons' decision-making between the two randomized groups was not substantially different. The negative appendectomy rate was 3.7%. CONCLUSION: Radiologic imaging with ultrasound and/or computed tomography provides valuable guidance whether a patient should be discharged, observed, or given surgical treatment, leading to beneficial changes in management plan. Still, false-negative results may occur and a close clinical re-examination is of utmost importance for the appropriate final decision.
Authors: Maria Michailidou; Maria G Sacco Casamassima; Omar Karim; Colin Gause; Jose H Salazar; Seth D Goldstein; Fizan Abdullah Journal: Pediatr Surg Int Date: 2015-02-21 Impact factor: 1.827
Authors: Morgan E Telesmanich; Robert C Orth; Wei Zhang; Monica E Lopez; Jennifer L Carpenter; Nadia Mahmood; Siddharth P Jadhav; R Paul Guillerman Journal: Pediatr Radiol Date: 2016-06-09