Is a pediatrician performed gray scale ultrasonography with power Doppler study safe and effective for triaging acute non-perforated appendicitis for conservative management?

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• 作者：Keisuke Jimbo^a ; Masahiro Takeda^b ; ^d ; ^{mstakeda@juntendo.ac.jp} ; Eri Miyata^a ; ^c ; Hiroshi Murakami^b ; Reiko Kyodo^a ; Hideki Orikasa^e ; Geoffrey J. Lane^b ; Toshiaki Shimizu^a ; Atsuyuki Yamataka^b ; ^d
• 关键词：Power Doppler study ; Acute non-perforated appendicitis ; Conservative management ; Interval appendectomy ; Emergency appendectomy
• 刊名：Journal of Pediatric Surgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：51
• 期：12
• 页码：1952-1956
• 全文大小：486 K
• 卷排序：51

文摘

The purpose of this study was to examine whether acute non-perforated appendicitis (ANPA) can be safely triaged by a pediatrician for conservative management (CM) using gray-scale ultrasonography with power Doppler (GSPD).MethodSeventy five cases of ANPA assessed by a pediatrician with GSPD (2013–2015) were reviewed. GSPD grading for ANPA was: I: slightly irregular wall/normal blood flow; II: irregular wall/increased blood flow; III: irregular wall/decreased blood flow; and IV: absence of wall/blood flow. Grades I/II were managed conservatively with intravenous antibiotics then encouraged to book for interval appendectomy (IA). Grades III/IV were reviewed for emergency appendectomy (EA) by a pediatric surgeon.ResultsGSPD grading was I (n = 26), II (n = 36), III (n = 9), and IV (n = 4). EA was required for 5 cases, one grade III, and four grade IV cases. One grade IV case was treated conservatively after surgical review but EA was unavoidable. Of the remaining 70 cases discharged well after a mean of 5.7 days hospitalization, 25/70 had IA with chronic inflammation on histology, 6/70 had recurrence of ANPA treated successfully by EA, and 39/70 remain asymptomatic at least 10 months after declining IA. Overall, GSPD triaging with CM was cheaper than surgery.ConclusionsGSPD performed by pediatricians appears to be safe/effective for triaging ANPA.Level of evidenceLevel III.