- 作者：Patrick M. Prendergast ; Naveen Poonai ; Tim Lynch ; Scott McKillop ; Rodrick Lim
- 关键词：ultrasound ; pediatric ; appendicitis ; diagnosis
- 刊名：Journal of Emergency Medicine
- 出版年：February, 2014
- 年：2014
- 卷：46
- 期：2
- 页码：157-164
- 全文大小：495 K
Background
Acute appendicitis is the most common cause of abdominal pain in children requiring operative intervention. Among a number of sonographic criteria to aid in the diagnosis of appendicitis, an outer diameter >6聽mm is the most objective and widely accepted. However, there is a lack of evidence-based standards governing this consensus.Study Objectives
The aim of this study was to determine the outer appendiceal diameter that maximizes sensitivity and specificity in a pediatric population.
Methods
A retrospective review of all urgent diagnostic ultrasounds (US) was performed over 2聽years in children aged聽<18聽years. The diagnostic accuracy of various cut-points was assessed by calculating the sensitivity and specificity and plotting a receiver operating characteristic (ROC) curve.
Results
The study sample consisted of 398 patients in whom the appendix was visualized on US. The median outer appendiceal diameter was significantly higher in the surgical group compared to the nonsurgical group (9.4聽mm; range聽=聽8.1-12.0 vs. 5.5聽mm; range聽=聽4.4-6.5, p聽<聽0.01). The optimal cut-point with the greatest area under the ROC curve was determined to be an outer appendiceal diameter of 7.0聽mm.
Conclusions
In our patients, adopting a 7-mm rather than a 6-mm appendiceal diameter threshold would balance a greater number of missed cases of acute appendicitis for a reduction in the number of unnecessary surgeries.