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1.
Patrick C. Bonasso Melvin S. Dassinger Deidre L. Wyrick Lori A. Gurien Jeffrey M. Burford Samuel D. Smith 《Journal of pediatric surgery》2018,53(11):2279-2289
Purpose
Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature involving PSPBUS.Methods
PSPBUS practices reviewed in this paper include central venous catheter placement, physiologic assessment (volume status and echocardiography), hypertrophic pyloric stenosis diagnosis, appendicitis diagnosis, the Focused Assessment with Sonography for Trauma (FAST), thoracic evaluation, and soft tissue infection evaluation.Results
There are no standards for the practice of PSPBUS.Conclusions
As the role of the pediatric surgeon continues to evolve, PSPBUS will influence practice patterns, disease diagnosis, and patient management.Type of Study
Review Article.Level of Evidence
Level III. 相似文献2.
Aim
To review children with Omental Infarction (OI) and the role of Ultrasound Scan (US) in its diagnosis and management.Methods
Cases of OI were identified retrospectively from 2004 to 2014 through screening of admission coding, pathology databases and radiology records. Demographic, clinical and pathological data were extracted from case records.Main Results
30 cases were identified (17 male, 13 female). Mean age was 10.7 years (range 3.5–17.2). The majority of the patients were grossly overweight, with 83.3% of patients weighing greater than the mean for their age. All patients underwent at least one US, 4 had a repeat US and 1 patient also had a CT to rule out appendicitis after a US demonstrating OI. OI was demonstrated in 26 initial USs; in 4 cases initial USs were negative but repeat USs correctly detected OI. In 34 USs the appendix was identified on 20 occasions (15 normal, equivocal in 5). 13 patients underwent surgery, while 17 were managed nonoperatively; 7 underwent omentectomy only, 5 had omentectomy plus appendicectomy and 1 underwent appendicectomy only. All 12 omentectomy specimens were confirmed as OI histologically while none of the 6 appendices showed inflammation histologically. There were no postoperative complications.Conclusion
In a large series we have demonstrated the efficacy of US in the diagnosis and management of OI in children. To our knowledge this is the largest series of its kind to date. No patient with OI was incorrectly diagnosed with acute appendicitis or vice versa.Level of evidence
Level IV.Type of Study
Retrospective Case Series. 相似文献3.
Pierre Gerbier Aurélien Binet Mathilde Etancelin Emmanuel Barteau Marie Auger Luciano Morales Philippe Bertrand Dominique Sirinelli Baptiste Morel 《Journal of pediatric surgery》2018,53(4):620-624
Purpose
The objective of this study was to evaluate the progress in performance of senior residents in diagnosing acute appendicitis.Material and methods
Results were collected and compared of ultrasound examinations performed for suspected acute appendicitis by three senior residents and two faculty members over a six-month period in a university hospital setting. A grid with the sonographic findings was completed separately by the residents and the faculty members immediately after each examination. The duration of each examination was reported. The final ultrasound diagnosis was compared to the surgical and pathological results and to the clinical follow-up.Results
The residents and faculty members performed 171 consecutive ultrasound examinations including 49 children with acute appendicitis and 122 with normal appendices. The accuracy of the diagnosis by the residents was 96%, and was similar to that of the faculty members (kappa = 0.90) over the six months. The duration of the resident ultrasound examinations was significantly shorter during the second three-month period (p = 0.01). No significant differences in diagnostic accuracy were demonstrated by the residents between the first and second three-month periods (p = 0.06).Conclusions
The residents performed well when using sonography to diagnose acute appendicitis in children, and were faster during the second three-month period.Level of evidence
I. 相似文献4.
Tishara Wijayanayaka Jacob Davidson Andreana Bütter 《Journal of pediatric surgery》2018,53(5):980-983
Purpose
The purpose of this study was to determine whether children with a positive ultrasound (US) for acute appendicitis but a negative clinical picture developed appendicitis requiring definitive management.Methods
After obtaining IRB approval, we conducted a retrospective review of patients ≤ 17 years who presented with possible acute appendicitis between April 1st, 2014, and December 31st, 2015. We included patients with a US suggestive of acute appendicitis based on size criteria but without concerning clinical features. Patients were discharged from the emergency department (ED) or admitted for observation. Variables included demographic data, US characteristics, clinical findings, length of follow-up, and appendectomy.Results
Of the 31 patients identified, 45% were male and average age was 11.3 yrs. On US, the average maximal diameter of the appendix was 6.93 mm. The median length of follow-up was 16.8 months, including 10 returns to the ED by 9 patients. Three of these underwent immediate laparoscopic appendectomy, while one had interval appendectomy. There were no cases of perforated appendicitis, and only 2 cases demonstrated pathology consistent with appendicitis.Conclusion
These findings demonstrate that it is safe to consider conservative measures such as observation or discharge in children with a positive US for appendicitis based on size criteria but a negative clinical picture.Level of Evidence
4 相似文献5.
Katie E. Rollins Krishna K. Varadhan Keith R. Neal Dileep N. Lobo 《World journal of surgery》2016,40(10):2305-2318
Background
Uncomplicated acute appendicitis has been managed traditionally by early appendicectomy. However, recently, there has been increasing interest in the potential for primary treatment with antibiotics, with studies finding this to be associated with fewer complications than appendicectomy. The aim of this study was to compare outcomes of antibiotic therapy with appendicectomy for uncomplicated acute appendicitis.Method
This meta-analysis of randomised controlled trials included adult patients presenting with uncomplicated acute appendicitis treated with antibiotics or appendicectomy. The primary outcome measure was complications. Secondary outcomes included treatment efficacy, hospital length of stay (LOS), readmission rate and incidence of complicated appendicitis.Results
Five randomised controlled trials with a total of 1430 participants (727 undergoing antibiotic therapy and 703 undergoing appendicectomy) were included. There was a 39 % risk reduction in overall complication rates in those treated with antibiotics compared with those undergoing appendicectomy (RR 0.61, 95 % CI 0.44–0.83, p = 0.002). There was no significant difference in hospital LOS (mean difference 0.25 days, 95 % CI ?0.05 to 0.56, p = 0.10). In the antibiotic cohort, 123 of 587 patients initially treated successfully with antibiotics were readmitted with symptoms suspicious of recurrent appendicitis. The incidence of complicated appendicitis was not increased in patients who underwent appendicectomy after “failed” antibiotic treatment (10.8 %) versus those who underwent primary appendicectomy (17.9 %).Conclusion
Increasing evidence supports the primary treatment of acute uncomplicated appendicitis with antibiotics, in terms of complications, hospital LOS and risk of complicated appendicitis. Antibiotics should be prescribed once a diagnosis of acute appendicitis is made or considered.6.
Yangyang R. Yu Richard Sola Somala Mohammed Joshua T. Lackey Sheena John Eric Rosenfeld Wei Zhang Shawn D. St. Peter Sohail R. Shah 《Journal of pediatric surgery》2018,53(10):2032-2035
Background
Patient-controlled analgesia (PCA) is often used in children with perforated appendicitis. To prevent urinary retention, some providers also routinely place Foley catheters.This study examines the necessity of this practice.Methods
We retrospectively reviewed all children (≤ 18?years old) with perforated appendicitis and postoperative PCA from 7/2015 to 6/2016 at two academic children's hospitals. Urinary retention was defined as the inability to spontaneously void requiring straight catheterization or placement of a Foley catheter.Results
Of 313 patients who underwent appendectomy for perforated appendicitis (Hospital 1: 175, Hospital 2: 138), 129 patients received an intraoperative Foley (Hospital 1: 22 [13%], Hospital 2: 107 [78%], p?<?0.001). Age, gender, and BMI were similar between those with an intraoperative Foley and those without. There were no urinary tract infections in either group.Urinary retention rate in patients with an intraoperative Foley following removal on the inpatient unit (n?=?3, 2%) and patients without an intraoperative Foley (n?=?10, 5%) did not reach significance (p?=?0.25). On univariate analysis, demographics, intraoperative findings, PCA specifics, postoperative abscess formation, and postoperative length of stay, were not significant risk factors for urinary retention.Conclusions
The risk of urinary retention in this population is low despite the use of PCA. Children with perforated appendicitis do not require routine Foley catheter placement to prevent urinary retention.Level of evidence
II 相似文献7.
8.
Lindsey B. Armstrong David P. Mooney Harriet Paltiel Carol Barnewolt Beatrice Dionigi Mary Arbuthnot Chinwendu Onwubiko Susan A. Connolly Delma Y. Jarrett Jill M. Zalieckas 《Journal of pediatric surgery》2018,53(3):548-552
Introduction
Blunt abdominal trauma is a common problem in children. Computed tomography (CT) is the gold standard for imaging in pediatric blunt abdominal trauma, however up to 50% of CTs are normal and CT carries a risk of radiation-induced cancer. Contrast enhanced ultrasound (CEUS) may allow accurate detection of abdominal organ injuries while eliminating exposure to ionizing radiation.Methods
Children aged 7–18 years with a CT-diagnosed abdominal solid organ injury underwent grayscale/power Doppler ultrasound (conventional US) and CEUS within 48 h of injury. Two blinded radiologists underwent a brief training in CEUS and then interpreted the CEUS images without patient interaction. Conventional US and CEUS images were compared to CT for the presence of injury and, if present, the injury grade. Patients were monitored for contrast-related adverse reactions.Results
Twenty one injured organs were identified by CT in eighteen children. Conventional US identified the injuries with a sensitivity of 45.2%, which increased to 85.7% using CEUS. The specificity of conventional US was 96.4% and increased to 98.6% using CEUS. The positive predictive value increased from 79.2% to 94.7% and the negative predictive value from 85.3% to 95.8%.Two patients had injuries that were missed by both radiologists on CEUS. In a 100 kg, 17 year old female, a grade III liver injury was not seen by either radiologist on CEUS. Her accompanying grade I kidney injury was not seen by one of the radiologist on CEUS. The second patient, a 16 year old female, had a grade III splenic injury that was missed by both radiologists on CEUS. She also had an adjacent grade II kidney injury that was seen by both.Injuries, when noted, were graded within 1 grade of CT 33/35 times with CEUS.There were no adverse reactions to the contrast.Conclusion
CEUS is a promising imaging modality that can detect most abdominal solid organ injuries in children while eliminating exposure to ionizing radiation. A multicenter trial is warranted before widespread use can be recommended.Level of evidence
Level II; Diagnostic Prospective Study. 相似文献9.
Richard Sola Stephanie B. Theut Kelly A. Sinclair Doug C. Rivard Kathy M. Johnson Huirong Zhu Shawn D. St. Peter Sohail R. Shah 《Journal of pediatric surgery》2018,53(5):984-987
Purpose
Our objective was to increase ultrasound reliability for diagnosing appendicitis in an academic children's hospital emergency department (ED) through a multidisciplinary quality improvement initiative.Methods
A retrospective review of ultrasound use in patients diagnosed with appendicitis in our ED from 1/1/2011 to 6/30/2014 established a baseline cohort. From 8/1/2014 to 7/31/2015 a diagnostic algorithm that prioritized ultrasound over CT was used in our ED, and a standardized template was implemented for the reporting of appendicitis-related ultrasound findings by our radiologists.Results
Of 627 patients diagnosed with appendicitis in the ED during the retrospective review, 46.1% (n = 289) had an ultrasound. After implementation of the diagnostic algorithm and standardized ultrasound report, 88.4% (n = 236) of 267 patients diagnosed with appendicitis had an ultrasound (p < 0.01). The frequency of indeterminate results decreased from 44.3% to 13.1%, and positive results increased from 46.4% to 66.1% in patients with appendicitis (p < 0.01). The sensitivity of ultrasound (indeterminate counted as negative) increased from 50.6% to 69.2% (p < 0.01).Conclusions
Ultrasound reliability for the diagnosis of appendicitis in children can be improved through standardized results reporting. However, these changes should be made as part of a multidisciplinary quality improvement initiative to account for the initial learning curve necessary to increase experience.Level of Evidence
Level II, Study of Diagnostic Test. 相似文献10.
Briana Leung Nikhil Madhuripan Katharine Bittner Vida Rastegar Gregory Banever David Tashjian Kevin Moriarty Stanley Polansky Michael Tirabassi 《Journal of pediatric surgery》2019,54(1):108-111
Background/Purpose
With recent improvements in imaging technology, subtler variations in the anatomy of the appendix can be appreciated. We hypothesized that radiographic findings of tip appendicitis may not correlate strongly with a pathologic diagnosis of appendicitis.Methods
Our radiology database was searched for reports of a diagnosis of tip appendicitis between January 2013 and June 2017 for patients between the ages of 2 and 17. Retrospective chart review was performed for demographic and clinical data, including outcomes. For patients managed operatively, the pathology results were reviewed for evidence of acute appendicitis. Patients managed nonoperatively and those with negative pathology were considered to not have appendicitis.Results
Fifty-five patients met inclusion criteria (31 boys and 24 girls); 46/55 patients with tip appendicitis on imaging ultimately did not have appendicitis. Twenty-one patients underwent appendectomy, and 9/21 had pathologic evidence of appendicitis. One patient had a ruptured appendix. No other pathology was identified in the negative appendectomies. Two patients managed nonoperatively required readmission, but not secondary to missed diagnosis of appendicitis.Conclusions
Ultrasound and CT findings of tip appendicitis may not accurately associate with a final diagnosis of acute appendicitis. Clinical judgment should ultimately dictate appropriate initial management, follow-up tests, and imaging.Type of Study
Diagnostic Study.Level of Evidence
Level III. 相似文献11.
Punam P. Parikh Jun Tashiro Amy E. Wagenaar Miosotys Curbelo Eduardo A. Perez Holly L. Neville Anthony R. Hogan Juan E. Sola 《Journal of pediatric surgery》2018,53(4):616-619
Background
Appendiceal ligation during pediatric laparoscopic appendectomy (LA) may be performed using looped suture versus stapler. Controversy regarding the utility of either method exists. Clinical outcomes and cost analysis of LA with both methods were compared.Methods
All pediatric LA were performed from fiscal years 2013 and 2014 by two pediatric surgeons. While one surgeon used looped suture, the other used stapler exclusively. chi-Square tests were performed to analyze associations.Results
Two hundred thirty-eight cases were analyzed where looped suture versus stapler LA was performed in 46% and 54% of patients, respectively. Operating room costs were $317.10 and $707.12/person for looped suture and stapler LA, respectively (P < 0.0001). Difference in cost of $390.02/person was attributed solely to ligation type. On bivariate analysis, rate of in-hospital complications, length of stay, return-to-ER and readmission within 30 days did not significantly differ between groups.Conclusion
A comparative analysis of looped suture versus stapler device during LA for pediatric appendicitis revealed that postoperative complications, length of stay, ER visits and readmissions were not significantly different. Looped suture LA was significantly more cost efficient than stapler LA. In pediatric appendicitis, appendiceal ligation during LA may be performed safely and cost effectively with looped suture versus stapler.Type of study
Cost effectivenessLevel of evidence
III. 相似文献12.
Steve M.M. de Castro Thijs H. Geerdink Sven Macco Ruben N. van Veen Sebastiaan Jensch Bart C. Vrouenraets 《Journal of pediatric surgery》2018,53(10):2028-2031
Objective
In children, the diagnosis “acute appendicitis” is difficult. In 2010, a new Dutch appendicitis guideline was published with the goal to reduce the negative appendectomy rate. The guideline recommended mandatory imaging (ultrasound first and CT or MRI when inconclusive) before surgery. This study examines whether the negative appendectomy rate in children has declined after the implementation of the guideline and if the number of ionising imaging procedures increased.Methods
In this cohort study, all consecutive patients aged 17 or younger, with the suspicion of appendicitis were included. Patients were divided into two groups. Those who presented between 2006 and 2010 (before the implementation) and those between 2011 and 2016 (after implementation).Results
In total, 748 children were enrolled, of which 363 children were seen before and 385 children after implementation of the guideline. Before implementation, 46% of the children with acute appendicitis underwent preoperative ultrasound compared with 95% in the post implementation group, p < 0.001. Any imaging was performed in 51% and 100%, respectively, p < 0.001. The percentage of negative appendectomy before implementation was 13% and 2.7% after implementation, p < 0.001. There was no significant increase in the number of CT scans before and after the implementation of the guideline, 3.6% versus 6.0%, respectively, p = 0.126. There was no increase in direct medical costs.Conclusions
Mandatory preoperative imaging in children with the suspicion of acute appendicitis results in a significant decrease in negative appendectomies with no increase in the number of CT scans and without a substantial increase in costs.Level of Evidence
III. 相似文献13.
Steven L. Lee Lara Spence Kyle Mock James X. Wu Huan Yan Daniel A. DeUgarte 《Journal of pediatric surgery》2018,53(1):42-47
Background
Carefully selected children with early appendicitis may be managed nonoperatively. However, it is unknown whether nonoperative management (NOM) is applicable to all patients with uncomplicated appendicitis. The purpose of this study was to evaluate the outcomes of NOM of uncomplicated appendicitis with expanded inclusion criteria.Methods
A prospective, nonrandomized patient-preference study comparing NOM versus laparoscopic appendectomy (LA) was performed in children with radiographic/clinical evidence of uncomplicated appendicitis.Results
Demographics, laboratory values, and clinical presentation were similar between the NOM (n = 51) and LA (n = 32) groups. Initial failure rate was 31%. The outcomes were similar between groups, except that NOM had fewer days of pain medication. Patients who failed NOM had a longer duration of symptoms prior to admission. Patients with appendicolith had a failure rate of 50% compared to 24% without appendicolith. The recurrence rate was 26%. Overall, 51% avoided appendectomy. Costs were similar between NOM and LA.Conclusions
When expanding the inclusion criteria for children with presumed uncomplicated appendicitis, NOM was associated with high failure and recurrence rates. These high rates may be because of the inclusion of patients with complicated appendicitis and patients with an appendicolith. Even in this setting of less-restrictive exclusion criteria, NOM remained cost neutral.Level of evidence
LEVEL II (Treatment Study: Prospective Comparative Study). 相似文献14.
Saurabh Saluja Tianyi Sun Jialin Mao Shaun A. Steigman P. Stephen Oh Heather L. Yeo Art Sedrakyan Demetri J. Merianos 《Journal of pediatric surgery》2018,53(7):1339-1344
Background
Complicated appendicitis is common in children, yet the timing of surgical management remains controversial. Some support initial antibiotics with delayed operation whereas others support immediate operation. While a few randomized trials have evaluated this question, they have been small, single-center trials with limited follow-up. We present a database analysis of outcomes in early versus late surgical management of complicated appendicitis with one-year follow-up.Methods
We conducted a retrospective review of children with complicated appendicitis presenting between 2000 and 2013, utilizing a New York State database. We compare children undergoing later versus early appendectomy with a primary outcome measure of any complication within one year as determined from ICD-9 codes.Results
8840 children were included in the analysis, 7708 of whom underwent early appendectomy. Patients with late appendectomy were significantly more likely to have at least one complication when compared to those undergoing early appendectomy (34.6% vs 26.7%, p < 0.01).Conclusions
We present the first population-level study evaluating early versus late appendectomy in children with complicated appendicitis with a one-year follow-up period. Children undergoing late appendectomy were more likely to have a complication than those undergoing early appendectomy. These data corroborated previous studies supporting early operative management.Level of evidence
This study provides level III evidence of a treatment study. 相似文献15.
Ramon R. Gorter Johanna H. van der Lee Florence A.C.J. Heijsters Huibert A. Cense Roel Bakx C.M. Frank Kneepkens Marc H. Wijnen Alida F.W. van der Steeg Klaas H. in&#x;t Hof Martin Offringa Hugo A. Heij 《Journal of pediatric surgery》2018,53(9):1849-1854
Purpose
To compare the outcome of initially nonoperative treatment with immediate appendectomy for simple appendicitis in children.Methods
Between September 2012 and June 2014 children aged 7–17 years with a radiologically confirmed simple appendicitis were invited to participate in a multicentre prospective cohort study in which they were treated with an initially nonoperative treatment strategy; nonparticipants underwent immediate appendectomy. In October 2015, their rates of complications and subsequent appendectomies, and health-related quality of life (HRQOL) were assessed.Results
In this period, 25 children were treated with an initially nonoperative treatment strategy and 19 with immediate appendectomy; median (range) follow-up was 25 (16–36) and 26 (17–34) months, respectively. The percentage [95%CI] of patients experiencing complications in the initially nonoperative group and the immediate appendectomy group was 12 [4–30]% and 11 [3–31]%, respectively. In total 6/25 children (24%) underwent an appendectomy; none of the 6 patients operated subsequently experienced any postappendectomy complications. Overall, HRQOL in the nonoperative treatment group was similar to that of healthy peers.Conclusions
Outcome of initially nonoperative treatment for acute simple appendicitis in children is similar to the outcome in those who undergo immediate appendectomy. Initially nonoperative management seems to be able to avoid appendectomy in 3 out of 4 children.Level of evidence
2 (prospective comparative study). This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors. 相似文献16.
Objective
To describe our technique of retrograde pericatheter urethrography (RPU) and its clinical use after urethroplasty.Subjects and methods
Between January 2008 and December 2013, 387 patients with urethral stricture underwent urethroplasty at our center. A total of 343 of these patients underwent RPU 3 weeks post-operatively. For this retrospective study their files were evaluated with regard to: demographics, duration of symptoms, site, mean length of stricture, type of surgery, RPU findings, contrast-medium related complications and need of re-intervention. The eventual surgical success was defined as asymptomatic voiding with no clinical evidence of residual stricture (good flow rate and no residual urine) until the last follow up.Results
Follow up ranged from 8 to 41 (mean 28) months. The mean duration of symptoms was 4.8 months. The mean stricture length, as seen on radiography, was 2.1 cm. 183 patients (53.3%) underwent anastomotic urethroplasty, while 160 (46.6%) underwent substitution urethroplasty. RPU showed urethral healing in 292 (85.2%) and contrast extravasation in 51 (14.8%) patients. No contrast-medium related complications were reported. Re-intervention was needed in 7.2% (21/292) of the patients who showed normal urethral healing and in 74.5% (38/51) of the patients who showed contrast extravasation on RPU. By the time of the last follow up the overall success rate was 82.7% (284/343 patients).Conclusion
RPU is the most useful radiological diagnostic method for evaluating the appropriate time for catheter removal after urethroplasty. It helps to assess urethral healing and patency after urethroplasty. Prolonged catheterization in patients showing contrast extravasation may be helpful. 相似文献17.
Hannah G. Povey Haran Selvachandran Robert T. Peters Matthew O. Jones 《Journal of pediatric surgery》2018,53(2):281-282
Aim of study
The aim of this study was to evaluate management of children with an anterior midline neck swelling by establishing 1) whether a preoperative ultrasound scan (USS) was appropriately requested, performed and reported; 2) whether there was preoperative infection; 3) whether a Sistrunk procedure was performed; 4) the rate of thyroglossal duct cyst (TGDC) recurrence following simple excision vs. Sistrunk procedure.Methods
A single centre retrospective study of children who underwent surgery for anterior midline neck swelling between April 2000 and May 2015 at our institution was performed. These were identified using a clinical coding system, and data were collected from electronic medical records, radiology, and histopathology reports. Recurrence rates between simple excision and Sistrunk groups were compared using Chi-square test.Main results
227 patients were identified (115 male, 112 female). 169 (74%) had a preoperative USS. The presence of a thyroid gland was stated in 79% of USS reports. This increased to 92% when the requesting surgeon had specifically asked about this. 48 (21%) patients underwent simple excision, while 175 (77%) had a Sistrunk procedure. Recurrence was significantly more likely following simple excision than a Sistrunk procedure (29% vs 6.9%; P < 0.0001). Of 25 TGDC recurrences, 9 (36%) had an inconclusive or alternative histopathological diagnosis at first operation.Conclusion
Preoperative USS should be performed in all patients with an anterior midline neck swelling. Appropriate requesting increases likelihood of a report confirming (or otherwise) the presence of a thyroid gland. A Sistrunk procedure is the operation of choice in all children presenting with an anterior midline neck swelling. The surgeon cannot reliably differentiate a TGDC from alternative pathology intraoperatively.Level of evidence
Treatment study: level IV. 相似文献18.
William Bonadio Syeda Shahid Lior Vardi Carly Buckingham Allison Kornblatt Chloe Free Peter Homel 《Journal of pediatric surgery》2018,53(3):441-445
Importance
Appendicitis is a common, potentially serious pediatric disease. An important factor in determining management strategy [whether/when to perform appendectomy, duration of antibiotic therapy/hospitalization, etc.] and predicting outcome is distinguishing whether perforation is present.Objective
The objective was to determine efficacy of commonly assessed pre-operative variables in stratifying perforation risk in children with appendicitis.Design
A retrospective analysis of consecutive cases was performed.Setting
The setting was a large urban hospital pediatric emergency department.Participants
Four hundred forty-eight consecutive cases of CT [computerized tomography]-confirmed pediatric appendicitis during a 6-year period in an urban pediatric ED [emergency department]: 162 with perforation and 286 non-perforated.Main outcome(s) and measure(s)
To determine efficacy of clinical and laboratory variables with distinguishing perforation outcome in children with appendicitis.Results
Regression analysis identified 3 independently significant variables associated with perforation outcome – and determined their ideal threshold values: duration of symptoms > 1 day; ED-measured fever [body temperature > 38.0 °C]; CBC WBC absolute neutrophil count > 13,000/mm3. The resulting multivariate ROC [receiver operating characteristic] curve after applying these threshold values gave an AUC [area under curve] of 89% for perforation outcome [p < 0.001]. Risk for perforation was additive with each additional predictive variable exceeding its threshold value, linearly increasing from 7% with no variable present to 85% when all 3 variables are present.Conclusions
A pre-operative scoring system comprised of 3 commonly assessed clinical/laboratory variables is useful in stratifying perforation risk in children with appendicitis.Physicians can utilize these factors to gauge pre-operative risk for perforation in children with appendicitis, which can potentially aid in planning subsequent management strategy.Level of evidence
III. 相似文献19.
Background
The conventional paradigm that all children with appendicitis require an appendectomy is being challenged by the idea that some patients may be successfully managed non-operatively. The study aimed to determine if matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) are candidate biomarkers for estimating the probability of complicated appendicitis in pediatric patients.Methods
The study was a single-institution, prospective cohort study. MMP and TIMP serum protein concentrations were measured in patients with suspected appendicitis. Three hundred and thirty-one patients were enrolled with appendicitis. Classification and Regression Tree (CART) analysis was used to determine the combination of candidate biomarkers that best predicted complicated appendicitis.Results
The CART-generated decision tree for the derivation cohort included WBC count, MMP-8, MMP-9, MMP-12, TIMP-2, and TIMP-4 and had the following test characteristics for estimating the probability of complicated appendicitis (95% CI): AUC 0.86 (0.81–0.90); sensitivity 91% (83–96); specificity 61% (53–68); positive predictive value 58% (50–66); negative predictive value 92% (84–96); positive likelihood ratio (LR) 2.3 (1.9–2.8); and negative LR 0.15 (0.08–0.3).Conclusions
MMPs and TIMPs have the potential to serve as biomarkers to estimate the probability of complicated appendicitis in pediatric patients. The multi-biomarker-based decision tree has test characteristics suggesting clinical utility for decision making.Level of Evidence
Level II: Study of Diagnostic Test. 相似文献20.
Danielle B. Cameron Regan Williams Yimin Geng Ankush Gosain Meghan A. Arnold Yigit S. Guner Martin L. Blakely Cynthia D. Downard Adam B. Goldin Julia Grabowski Dave R. Lal Roshni Dasgupta Robert Baird Robert L. Gates Julia Shelton Tim Jancelewicz Shawn J. Rangel Mary T. Austin 《Journal of pediatric surgery》2018,53(3):396-405