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SonoKids ABD appy

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40 papers 0 to 25 followers
Y Liza Kearl, Ilene Claudius, Sol Behar, John Cooper, Ryan Dollbaum, Madhu Hardasmalani, Kevin Hardiman, Emily Rose, Genevieve Santillanes, Carl Berdahl
OBJECTIVES: Suggestive radiographic studies with nonvisualization of the appendix can present a challenge to clinicians in the evaluation of pediatric abdominal pain. The primary objective of this study was to quantify the accuracy of magnetic resonance imaging (MRI) and of ultrasound (US) in the setting of nonvisualization of the appendix. Secondary objectives reported include sensitivity of MRI and US overall and correlation between MRI and US for diagnosis of appendicitis. METHODS: Records of pediatric emergency department patients aged 3 to 21 years undergoing MRI and/or US for the evaluation of appendicitis were retrospectively reviewed...
February 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Aaron E Kornblith, Stephanie J Doniger
We present two cases of pediatric patients initially presenting with a clinical suspicion of acute appendicitis. In these cases, point-of-care ultrasonography was performed early in the patient's emergency department course, leading to alternate diagnoses. This article highlights a role for point-of-care ultrasound in the diagnoses of two alternate conditions that clinically mimic appendicitis: Meckel diverticulitis and acute ileocecitis. We offer a brief overview of terminology, relevant literature, and ultrasound scanning technique for the right-lower-quadrant point-of-care ultrasound evaluation...
April 2016: Pediatric Emergency Care
Peggy Tseng, Carl Berdahl, Y Liza Kearl, Solomon Behar, John Cooper, Ryan Dollbaum, Madhu Hardasmalani, Kevin Hardiman, Emily Rose, Genevieve Santillanes, ChunNok Lam, Ilene Claudius
BACKGROUND: Acute appendicitis is the most common cause of acute abdomen in pediatric emergency department (ED) visits, and right lower quadrant abdominal ultrasound (RLQUS) is a valuable diagnostic tool in the clinical approach. The utility of ultrasound in predicting perforation has not been well-defined. OBJECTIVES: We sought to determine the sensitivity of RLQUS to identify perforation in pediatric patients with appendicitis. METHODS: A chart review of all patients 3 to 21 years of age who received a radiographic work-up and who were ultimately diagnosed with perforated appendicitis between 2010 and 2013 at a pediatric ED was conducted...
April 2016: Journal of Emergency Medicine
Sara Leibovich, Stephanie J Doniger
We present the use of point-of-care ultrasound to evaluate two patients with examinations concerning for appendicitis who were found to have multiple magnets ingested and subsequent bowel perforations. These cases illustrate the consequences of magnet ingestion as well as the application of point-of-care ultrasound for the identification of intestinal foreign bodies in children.
October 2015: Pediatric Emergency Care
Changsun Kim, Bo Seung Kang, Hyuk Joong Choi, Tae Ho Lim, Jaehoon Oh, Youngjoon Chee
PURPOSE: We investigated the effectiveness of tele-mentored ultrasonography between emergency medicine (EM) residents and remote experts in diagnosing acute appendicitis. METHODS: This prospective observational study was performed in an academic emergency department. Beginning in June 2014, the EM residents performed the initial ultrasonography for suspected pediatric acute appendicitis; then, the remote experts observed/mentored the residents' practice using the tele-ultrasonography system; and finally, an onsite expert verified the diagnosis...
October 2015: American Journal of Emergency Medicine
Larry A Binkovitz, Kyle M L Unsdorfer, Prabin Thapa, Amy B Kolbe, Nathan C Hull, Shannon N Zingula, Kristen B Thomas, James L Homme
BACKGROUND: Ultrasonography is considered the most appropriate initial imaging study in the evaluation of acute appendicitis in children but has recently come under criticism with reports of low specificity and high indeterminate study rates, particularly when used in obese patients and patients early in the course of their disease, or when performed by sonographers with limited experience. OBJECTIVE: To (1) assess the impact of patient factors (gender, age, body mass index, and symptom duration) and system factors (call status or year of exam) on pediatric appendiceal US accuracy and indeterminate study rate, (2) assess the impact of indeterminate study results on follow-up CT and negative laparotomy rates and (3) present strategies to reduce the rate of indeterminate US studies and improve accuracy...
December 2015: Pediatric Radiology
Sara C Fallon, Robert C Orth, R Paul Guillerman, Martha M Munden, Wei Zhang, Simone C Elder, Andrea T Cruz, Mary L Brandt, Monica E Lopez, George S Bisset
BACKGROUND: To facilitate consistent, reliable communication among providers, we developed a scoring system (Appy-Score) for reporting limited right lower quadrant ultrasound (US) exams performed for suspected pediatric appendicitis. OBJECTIVE: The purpose of this study was to evaluate implementation of this scoring system and its ability to risk-stratify children with suspected appendicitis. MATERIALS AND METHODS: In this HIPAA compliant, Institutional Review Board-approved study, the Appy-Score was applied retrospectively to all limited abdominal US exams ordered for suspected pediatric appendicitis through our emergency department during a 5-month pre-implementation period (Jan 1, 2013, to May 31, 2013), and Appy-Score use was tracked prospectively post-implementation (July 1, 2013, to Sept...
December 2015: Pediatric Radiology
Haven Roy, Brent Burbridge
BACKGROUND: Appendicitis is a common pediatric query. However, obesity often results in nondiagnostic ultrasounds and increased likelihood of abdominal computed tomography (CT). Concern regarding radiation exposure led the Canadian Association of Radiologists to recommend foregoing CT when ultrasounds are nondiagnostic and clinical suspicion is high. We evaluated this recommendation by quantifying the influence of CT on the diagnosis of pediatric appendicitis. METHODS: We performed a 2-year retrospective case series of children presenting with suspected appendicitis...
June 2015: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Deidre L Wyrick, Samuel D Smith, Jeffrey M Burford, Melvin S Dassinger
PURPOSE: A study previously performed at our institution demonstrated that surgeon-performed ultrasound (SPUS) was accurate compared to radiology department ultrasound (RDUS) when evaluating children with suspected appendicitis. The purpose of this study was to determine if these results were reproducible and if SPUS decreased time to definitive diagnosis. METHODS: A surgery resident performed examinations and ultrasounds on children with suspected appendicitis...
December 2015: Pediatric Surgery International
Joseph Minardi, Erica Shaver, Aaron Monseau, Adam Pratt, Shelley M Layman
BACKGROUND: Right lower quadrant pain in young females presents a frequent diagnostic challenge for emergency physicians, with a broad differential and several important diagnoses. Using an "ultrasound first" imaging strategy can help decrease the use of computed tomography scans, with associated savings in radiation exposure, cost, and other resource use. CASE REPORT: We report a case of right lower quadrant pain in a young woman. After her initial history and physical examination, appendicitis was the leading differential...
November 2015: Journal of Emergency Medicine
Richard G Bachur, Jason A Levy, Michael J Callahan, Shawn J Rangel, Michael C Monuteaux
IMPORTANCE: Advanced diagnostic imaging is commonly used in the evaluation of suspected appendicitis in children. Despite its inferior diagnostic performance, ultrasonography (US) is now preferred to computed tomography (CT) owing to concerns about ionizing radiation exposure. With changes in imaging modalities, the influence on outcomes should be assessed. OBJECTIVES: To review trends in the use of US and CT for children with appendicitis and to investigate simultaneous changes in the proportions of negative appendectomy, appendiceal perforation, and emergency department (ED) revisits...
August 2015: JAMA Pediatrics
Netta M Blitman, Muhammad Anwar, KeriAnne B Brady, Benjamin H Taragin, Katherine Freeman
OBJECTIVE: The purpose of this study was to evaluate the effectiveness of focused appendicitis ultrasound combined with Alvarado score to accurately identify appendicitis in children in whom it is suspected, thereby reducing unnecessary CT examinations and associated radiation exposure. MATERIALS AND METHODS: We retrospectively evaluated the focused appendicitis ultrasound, CT, clinical, and laboratory findings of 522 consecutively registered children (231 boys, 291 girls; mean age, 13...
June 2015: AJR. American Journal of Roentgenology
Amy E Wagenaar, Jun Tashiro, Bo Wang, Miosotys Curbelo, Kenneth L Mendelson, Eduardo A Perez, Anthony R Hogan, Holly L Neville, Juan E Sola
BACKGROUND: Despite radiation concerns, computed tomography (CT) remains the favored imaging modality at many children's hospitals for appendicitis. We sought to reduce CT utilization for appendicitis in a children's hospital with an algorithm relying on 24-h ultrasound (US) as the primary imaging study. MATERIALS AND METHODS: An US-based protocol for suspected appendicitis was adopted at the end of the fiscal year (FY) 2011. Data were collected for 12 mo before and 24 mo after implementation...
November 2015: Journal of Surgical Research
Suzanne Schuh, Kevin Chan, Jacob C Langer, Dina Kulik, Marcela Preto-Zamperlini, Nadine Al Aswad, Carina Man, Arun Mohanta, Derek Stephens, Andrea S Doria
OBJECTIVES: The primary objective was to determine the diagnostic accuracy of a serial ultrasound (US) clinical diagnostic pathway to detect appendicitis in children presenting to the emergency department (ED). The secondary objective was to examine the diagnostic performance of the initial and interval US and to compare the accuracy of the pathway to that of the initial US. METHODS: This was a prospective cohort study of 294 previously healthy children 4 to 17 years old with suspected appendicitis and baseline pediatric appendicitis scores of ≥2, who were managed with the serial US clinical diagnostic pathway...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
David B Larson, Andrew T Trout, Shelby R Fierke, Alexander J Towbin
OBJECTIVE: The purpose of this article is to evaluate the diagnostic performance of ultrasound of the pediatric appendix using standardized structured reports that incorporate equivocal interpretive categories. MATERIALS AND METHODS: Standardized structured appendix ultrasound reports using a five-category interpretive scheme were reviewed. Interpretive categories were positive, intermediate likelihood, or negative when the appendix was visualized, and secondary signs or no secondary signs when the appendix was not visualized...
April 2015: AJR. American Journal of Roentgenology
Reza Khorramirouz, Amin Bagheri, Alireza Aalam Sahebpour, Abdol-Mohammad Kajbafzadeh
Inguinal hernia with acute appendicitis known as Amyand's hernia is uncommon. It may clinically manifest as acute scrotum, inguinal lymphadenitis, or strangulated hernia. The presentation of Amyand's hernia with acute scrotum has been rarely described. Also, the manifestation of infarcted omentum in the inguinal hernia has been described in one case previously. However, the coexistence of perforated appendix with infarcted omentum in the hernia sac which manifests acute scrotum has not been described previously...
2015: Case Reports in Surgery
Meera Kotagal, Morgan K Richards, Teresa Chapman, Lisa Finch, Bessie McCann, Amaya Ormazabal, Robert J Rush, Adam B Goldin
BACKGROUND: Safety concerns about the use of radiation-based imaging such as computed tomography (CT) in children have resulted in national recommendations to use ultrasound (US) for the diagnosis of appendicitis when possible. We evaluated the trends in CT and US use in a statewide sample and the accuracy of these modalities. METHODS: Patients less than or equal to 18 years undergoing appendectomy in Washington State from 2008 to 2013 were evaluated for preoperative US/CT use, as well as imaging/pathology concordance using data from the Surgical Care and Outcomes Assessment Program...
May 2015: American Journal of Surgery
Marzieh Fathi, Seyyed Abbas Hasani, Mohammad Amin Zare, Marzieh Daadpey, Nader Hojati Firoozabadi, Daniyal Lotfi
PURPOSE: Accurate early diagnosis of appendicitis can decrease its complications and minimize the mortality, morbidity and costs. This prospective study evaluates the accuracy of bedside emergency physician performed ultrasound study diagnosis in acute appendicitis. METHODS: Patients who were suspicious to have appendicitis based on their clinical findings were included and underwent emergency physician performed ultrasound study. Then they were followed up until the recognition of final diagnosis based on pathology report or identification of an alternative diagnosis...
March 2015: Journal of Ultrasound
Richard G Bachur, Michael J Callahan, Michael C Monuteaux, Shawn J Rangel
OBJECTIVE: To determine the predictive value of ultrasonography (US) for appendicitis in children when combined with clinical assessment based on the Pediatric Appendicitis Score (PAS). STUDY DESIGN: Observational study of children aged 3-18 years who had an US examination for possible appendicitis. A PAS was calculated on the basis of historical elements, examination, and laboratory studies and was used to classify patients into 3 risk groups (low, medium, high)...
May 2015: Journal of Pediatrics
Jay Pershad, Teresa M Waters, Max R Langham, Tao Li, Eunice Y Huang
BACKGROUND: Our group recently published a clinical pathway (Le Bonheur Clinical Pathway [LeB-P]) that used the Samuel Pediatric Appendicitis Score with selective use of ultrasonography (USG) for diagnosis of children at risk for appendicitis. The objective of this study was to model the cost-effectiveness of implementing the LeB-P compared with usual care. STUDY DESIGN: We constructed a decision analytic model comparing hospital costs for the following diagnostic strategies for suspected appendicitis: emergency department clinician judgment alone, USG on all patients, CT on all patients, overnight observation with surgical evaluation without studies, and the LeB-P...
April 2015: Journal of the American College of Surgeons
2015-02-12 17:10:03
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