PMID- 27692650
DCOM- 20171102
LR  - 20171102
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 52
IP  - 3
DP  - 2017 Mar
TI  - Predictors of Nondiagnostic Ultrasound for Appendicitis.
PG  - 318-323
LID - S0736-4679(16)30557-1 [pii]
LID - 10.1016/j.jemermed.2016.07.101 [doi]
AB  - BACKGROUND: Ionizing radiation and cost make ultrasound (US), when available, the
      first imaging study for the diagnosis of suspected pediatric appendicitis. US is 
      less sensitive and specific than computed tomography (CT) or magnetic resonance
      imaging (MRI) scans, which are often performed after nondiagnostic US.
      OBJECTIVES: We sought to determine predictors of nondiagnostic US in order to
      guide efficient ordering of imaging studies. METHODS: A prospective cohort study 
      of consecutive patients 4 to 30 years of age with suspected appendicitis took
      place at an emergency department with access to 24/7 US, MRI, and CT
      capabilities. Patients with US as their initial study were identified. Clinical
      (i.e., duration of illness, highest fever, and right lower quadrant pain) and
      demographic (i.e., age and sex) variables were collected. Body mass index (BMI)
      was calculated based on Centers for Disease Control and Prevention criteria; BMI 
      >85th percentile was categorized as overweight. Patients were followed until day 
      7. Univariate and stepwise multivariate logistic regression analysis was
      performed. RESULTS: Over 3 months, 106 patients had US first for suspected
      appendicitis; 52 (49%) had nondiagnostic US results. Eighteen patients had
      appendicitis, and there were no missed cases after discharge. On univariate
      analysis, male sex, a yearly increase in age, and overweight BMI were associated 
      with nondiagnostic US (p < 0.05). In the multivariate model, only BMI (odds ratio
      4.9 [95% CI 2.0-12.2]) and age (odds ratio 1.1 [95% CI 1.02-1.20]) were
      predictors. Sixty-eight percent of nondiagnostic US results occurred in
      overweight patients. CONCLUSION: Overweight and older patients are more likely to
      have a nondiagnostic US or appendicitis, and it may be more efficient to consider
      alternatives to US first for these patients. Also, this information about the
      accuracy of US to diagnose suspected appendicitis may be useful to clinicians who
      wish to engage in shared decision-making with the parents or guardians of
      children regarding imaging options for children with acute abdominal pain.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Keller, Christine
AU  - Keller C
AD  - Department of Emergency Medicine, Stanford University, Stanford, California.
FAU - Wang, Nancy E
AU  - Wang NE
AD  - Division of Pediatric Emergency Medicine, Stanford University, Stanford,
FAU - Imler, Daniel L
AU  - Imler DL
AD  - Division of Pediatric Emergency Medicine, Stanford University, Stanford,
FAU - Vasanawala, Shreyas S
AU  - Vasanawala SS
AD  - Department of Pediatric Radiology, Stanford University, Stanford, California.
FAU - Bruzoni, Matias
AU  - Bruzoni M
AD  - Division of Pediatric Surgery, Stanford University, Stanford, California.
FAU - Quinn, James V
AU  - Quinn JV
AD  - Department of Emergency Medicine, Stanford University, Stanford, California.
LA  - eng
PT  - Journal Article
DEP - 20160928
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
SB  - IM
MH  - Abdominal Pain/etiology
MH  - Adolescent
MH  - Adult
MH  - Appendicitis/*diagnosis/physiopathology
MH  - *Body Mass Index
MH  - Child
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Emergency Service, Hospital/organization & administration/statistics & numerical 
MH  - Female
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Multivariate Analysis
MH  - Obesity/complications/physiopathology
MH  - Overweight/complications/physiopathology
MH  - Prospective Studies
MH  - Ultrasonography/*standards/statistics & numerical data
OT  - appendicitis
OT  - body mass index
OT  - nonvisualized appendix
OT  - ultrasound
EDAT- 2016/10/04 06:00
MHDA- 2017/11/03 06:00
CRDT- 2016/10/04 06:00
PHST- 2016/02/23 00:00 [received]
PHST- 2016/06/29 00:00 [revised]
PHST- 2016/07/20 00:00 [accepted]
PHST- 2016/10/04 06:00 [pubmed]
PHST- 2017/11/03 06:00 [medline]
PHST- 2016/10/04 06:00 [entrez]
AID - S0736-4679(16)30557-1 [pii]
AID - 10.1016/j.jemermed.2016.07.101 [doi]
PST - ppublish
SO  - J Emerg Med. 2017 Mar;52(3):318-323. doi: 10.1016/j.jemermed.2016.07.101. Epub
      2016 Sep 28.