急诊科即时超声鉴别复杂与非复杂阑尾炎的前瞻性观察研究。

IF 2.1 4区 医学 Q2 ACOUSTICS
Almaz S Dessie, Maria Kwok, Lisa Mills, Adam Sivitz, Marsha Elkhunovich, Benjamin Nti, Erika Constantine, Kelly Bergmann, Atim Ekpenyong, Amanda Toney, Xiaoyang Li, Peter S Dayan, David Kessler
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引用次数: 0

摘要

目的:急性阑尾炎是儿童常见的外科急症。先前的放射学研究描述了超声的Puylaert分期,以确定阑尾炎的严重程度。我们研究了在急诊科(ED)即时超声(POCUS)上评估Puylaert分期以区分儿童阑尾炎的可行性和实用性。方法:对9个儿科急诊科5-17岁诊断为急性阑尾炎的儿童进行初步可行性研究。POCUS由训练有素的急诊科医生执行。采用粘膜下层的Puylaert分期对阑尾炎的严重程度进行分类(1-4期),并与手术病理报告进行比较。计算测试特征以评估POCUS在区分阑尾炎严重程度方面的准确性。医生记录了完成POCUS的时间、易用性以及患者和家属对他们的接受程度。结果:在72例资料完整的患者中,所有无并发症的阑尾炎患者均通过POCUS (Puylaert 1期或2期)准确识别。识别复杂性阑尾炎(Puylaert 3期或4期)的敏感性为100% (95% CI: 77%-100%),特异性为65% (95% CI: 52%-78%)。94%的医生认为POCUS很容易操作。百分之百的人认为这是被家庭接受的。完成POCUS的平均时间为8分钟。结论:本研究支持POCUS对急诊科阑尾炎患儿进行Puylaert分期评估的可行性和实用性。排除复杂病例的高敏感性,加上易于使用和患者可接受性,使其成为帮助治疗小儿阑尾炎的潜在辅助手段。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prospective Observational Study of Emergency Department Point-of-Care Ultrasound to Differentiate Between Complicated and Uncomplicated Appendicitis.

Objectives: Acute appendicitis is a common surgical emergency in children. Prior radiology studies have described Puylaert staging on ultrasound to determine the severity of appendicitis. We investigated the feasibility and utility of assessing Puylaert staging on emergency department (ED) point-of-care ultrasound (POCUS) to differentiate uncomplicated from complicated appendicitis in children.

Methods: This was a pilot feasibility study of children ages 5-17 diagnosed with acute appendicitis in nine pediatric EDs. POCUS was performed by trained ED physicians. Puylaert staging of the submucosal layer was used to categorize the severity of appendicitis (stages 1-4) and was compared with surgical pathology reports. Test characteristics were computed to evaluate the accuracy of POCUS in differentiating appendicitis severity. Physicians recorded time to complete POCUS, ease of use, and their perception of acceptability by patients and families.

Results: Of 72 patients with complete data, all patients with uncomplicated appendicitis were accurately identified using POCUS (Puylaert stage 1 or 2). The sensitivity for identifying complicated appendicitis (Puylaert Stage 3 or 4) was 100% (95% CI: 77%-100%), and specificity was 65% (95% CI: 52%-78%). Ninety four percent of physicians agreed that the POCUS was easy to perform. One hundred percent agreed that it was well accepted by families. The average time to complete POCUS was 8 min.

Conclusions: This study supports the feasibility and utility of assessing Puylaert staging by POCUS for children with appendicitis in the ED. High sensitivity to rule out complicated cases coupled with ease of use and perceived patient acceptance make this a potential adjunct to aid in the management of pediatric appendicitis.

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来源期刊
CiteScore
5.10
自引率
4.30%
发文量
205
审稿时长
1.5 months
期刊介绍: The Journal of Ultrasound in Medicine (JUM) is dedicated to the rapid, accurate publication of original articles dealing with all aspects of medical ultrasound, particularly its direct application to patient care but also relevant basic science, advances in instrumentation, and biological effects. The journal is an official publication of the American Institute of Ultrasound in Medicine and publishes articles in a variety of categories, including Original Research papers, Review Articles, Pictorial Essays, Technical Innovations, Case Series, Letters to the Editor, and more, from an international bevy of countries in a continual effort to showcase and promote advances in the ultrasound community. Represented through these efforts are a wide variety of disciplines of ultrasound, including, but not limited to: -Basic Science- Breast Ultrasound- Contrast-Enhanced Ultrasound- Dermatology- Echocardiography- Elastography- Emergency Medicine- Fetal Echocardiography- Gastrointestinal Ultrasound- General and Abdominal Ultrasound- Genitourinary Ultrasound- Gynecologic Ultrasound- Head and Neck Ultrasound- High Frequency Clinical and Preclinical Imaging- Interventional-Intraoperative Ultrasound- Musculoskeletal Ultrasound- Neurosonology- Obstetric Ultrasound- Ophthalmologic Ultrasound- Pediatric Ultrasound- Point-of-Care Ultrasound- Public Policy- Superficial Structures- Therapeutic Ultrasound- Ultrasound Education- Ultrasound in Global Health- Urologic Ultrasound- Vascular Ultrasound
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