Properties of ultrasound-rapid MRI clinical diagnostic pathway in suspected pediatric appendicitis - 03/08/23
, Carina Man b, Eman Marie, M.B. Ch.B., M.Sc. b, Ghufran Hassan A. Alhashmi, MD d, Dan Halevy, MD(C) b, Paul W. Wales, MD(C) e, Dana Singer-Harel, MD(C) a, Aya Finkelstein c, Judith Sweeney, BScN c, Andrea S. Doria, MD(C) PhD b, cAbstract |
Objective |
to determine diagnostic accuracy of an US-MRI clinical diagnostic pathway to detect appendicitis in the emergency department (ED).
Study design |
prospective cohort study of 624 previously healthy children 4–17 years old undergoing US for suspected appendicitis and clinical re-assessment. Children with non-diagnostic USs and persistent appendicitis concern/conclusive US-reassessment discrepancies underwent ultra-rapid MRI (US-MRI pathway), interpreted as positive, negative or non-diagnostic. Cases with missed appendicitis, negative appendectomies, and CT utilization were considered clinically diagnostically inaccurate. Primary outcome was the proportion of accurate diagnoses of appendicitis/lack thereof by the pathway.
Results |
150/624 (24%) children had appendicitis;255 USs (40.9%) were non-diagnostic. Of 139 US-MRI pathway children (after 117 non-diagnostic and 22 conclusive USs), 137 [98.6%; 95% CI 0.96–1.00] had clinically accurate outcomes (1 CT, 1 negative appendectomy): sensitivity 18/18 [100%], specificity 119/121 [98.3%], positive predictive value 18/20 [90.5%], negative predictive value 119/119 [100%]. MRI imaging accuracy was 134/139 (96.4%); 3 MRIs were non-diagnostic (no appendicitis).
In the overall algorithm, 616/624 [98.7% (0.97–0.99)] patients had accurate outcomes: 147/150 (98.0%) appendicitis cases had confirmatory surgeries (3 CTs) and 469/474 (98.9%) appendicitis-negative children had no surgery/CT.
Conclusion |
this study demonstrated high clinical accuracy of the US-rapid-MRI pathway in suspected pediatric appendicitis after non-diagnostic US.
Le texte complet de cet article est disponible en PDF.Keywords : Children, Appendicitis, Ultrasound, MRI
Plan
Vol 71
P. 217-224 - septembre 2023 Retour au numéro
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