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Giorno EP, Foronda FK, De Paulis M, Bou Gohsn DN, Couto TB, Sa FV, Fraga AM, Farhat SC, Preto-Zamperlini M, Schvartsman C. Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress. Am J Emerg Med 2023; 68:112-118. [PMID: 36966586 DOI: 10.1016/j.ajem.2023.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE Respiratory distress due to lower respiratory illnesses is a leading cause of death in children. Early recognition of high-risk populations is critical for the allocation of adequate resources. Our goal was to assess whether the lung ultrasound (US) score obtained at admission in children with respiratory distress predicts the need for escalated care. METHODS This prospective study included 0-18-year-old patients with respiratory distress admitted to three emergency departments in the state of Sao Paulo, Brazil, between July 2019 and September 2021. The enrolled patients underwent lung US performed by a pediatric emergency physician within two hours of arrival. Lung ultrasound scores ranging from 0 to 36 were computed. The primary outcome was the need for high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation within 24 h. RESULTS A total of 103 patients were included. The diagnoses included wheezing (33%), bronchiolitis (27%), pneumonia (16%), asthma (9%), and miscellaneous (16%). Thirty-five patients (34%) required escalated care and had a higher lung ultrasound score: median 13 (0-34) vs 2 (0-21), p < 0.0001; area under the curve (AUC): 0.81 (95% confidence interval [CI]: 0.71-0.90). The best cut-off score derived from Youden's index was seven (sensitivity: 71.4%; specificity: 79.4%; odds ratio (OR): 9.6 [95% CI: 3.8-24.7]). A lung US score above 12 was highly specific and had a positive likelihood ratio of 8.74 (95% CI:3.21-23.86). CONCLUSION An elevated lung US score measured in the first assessment of children with any type of respiratory distress was predictive of severity as defined by the need for escalated care with HFNC, NIV, or mechanical ventilation.
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Preto-Zamperlini M, Giorno EPC, Bou Ghosn DSN, Sá FVM, Suzuki AS, Suzuki L, Farhat SC, Weerdenburg K, Schvartsman C. Point-of-care lung ultrasound is more reliable than chest X-ray for ruling out acute chest syndrome in sickle cell pediatric patients: A prospective study. Pediatr Blood Cancer 2022; 69:e29283. [PMID: 34931750 DOI: 10.1002/pbc.29283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute chest syndrome (ACS) is a leading cause of morbidity and mortality in sickle cell patients, and it is often challenging to establish its diagnosis. PROCEDURE This was a prospective observational study conducted in a pediatric emergency (PEM) department. We aimed to investigate the performance characteristics of point-of-care lung ultrasound (LUS) for diagnosing ACS in sickle cell children. LUS by trained PEM physicians was performed and interpreted as either positive or negative for consolidation. LUS results were compared to chest X-ray (CXR) and discharge diagnosis as reference standards. RESULTS Four PEM physicians performed the LUS studies in 79 suspected ACS cases. The median age was 8 years (range 1-17 years). Fourteen cases (18%) received a diagnosis of ACS based on CXR and 21 (26.5%) had ACS discharge diagnosis. Comparing to CXR interpretation as the reference standard, LUS had a sensitivity of 100% (95% CI: 77%-100%), specificity of 68% (95% CI: 56%-79%), positive predictive value of 40% (95% CI: 24%-56%), and negative predictive value of 100% (95% CI: 92%-100%). Overall LUS accuracy was 73.42% (95% CI: 62%-83%). Using discharge diagnosis as the endpoint for both CXR and LUS, LUS had significantly higher sensitivity (100% vs. 62%, p = .0047) and lower specificity (76% vs.100%, p = .0002). LUS also had lower positive (60% vs.100%, p < .0001) and higher negative (100% vs.77%, p = .0025) predictive values. The overall accuracy was similar for both tests (82% vs. 88%, p = .2593). CONCLUSION The high negative predictive value, with narrow CIs, makes LUS an excellent ruling-out tool for ACS.
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Affiliation(s)
- Marcela Preto-Zamperlini
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Eliana P C Giorno
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Danielle S N Bou Ghosn
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Fernanda V M Sá
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Adriana S Suzuki
- Intensive Care Unit, Hematology-Oncology Division, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Lisa Suzuki
- Radiology Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Sylvia C Farhat
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Kirstin Weerdenburg
- Department of Emergency Medicine IWK Health Center and Dalhousie University, Halifax, Nova Scotia, Canada.,IWK Health Center, Halifax, Nova Scotia, Canada
| | - Claudio Schvartsman
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.,Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, Brazil
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Bello FPS, Preto-Zamperlini M, Schvartsman C, Farhat SCL. Reply to "Does timing of endoscopy matter for acute upper gastrointestinal bleeding in pediatric portal hypertension?". Dig Liver Dis 2022; 54:146-147. [PMID: 34852979 DOI: 10.1016/j.dld.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/05/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Affiliation(s)
| | - Marcela Preto-Zamperlini
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Cláudio Schvartsman
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Sylvia Costa Lima Farhat
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil.
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Bello FPS, Cardoso S, Tannuri AC, Preto-Zamperlini M, Schvartsman C, Farhat SCL. Acute upper gastrointestinal bleeding due to portal hypertension in children: What is the best timing of endoscopy? Dig Liver Dis 2022; 54:63-68. [PMID: 34625365 DOI: 10.1016/j.dld.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare initial clinical/laboratory parameters and outcomes of mortality/rebleeding of endoscopy performed <12 h(early UGIE) versus endoscopy performed after 12-24h(late UGIE) of ED admission in children with acute upper gastrointestinal bleeding(AUGIB) due to portal hypertension. METHODS This is a retrospective cohort study. From January 2010 to July 2017, medical records of all children admitted to a tertiary care hospital with AUGIB due to portal hypertension were reviewed until 60 days after ED admission. RESULTS A total of 98 ED admissions occurred from 73 patients. Rebleeding was identified in 8/98(8%) episodes, and 9 deaths were observed. UGIE was performed in 92(94%) episodes, and 53(58%) of them occurred within 12 h of ED admission. Episodes with early UGIE and late UGIE were similar in terms of history/complaints/laboratory data at admission, chronic liver disease associated, AUGIB duration, and initial management. No statistically significant associations were found between early UGIE and the outcomes of death/rebleeding and prevalence of endoscopic hemostatic treatment (band ligation or sclerotherapy) compared to late UGIE. In the multivariable logistic regression model, the endoscopic hemostatic treatment showed a negative association with early UGIE(OR=0.33;95%CI=0.1-0.9;p = 0.04). CONCLUSIONS This study suggests that in pediatric patients with AUGIB and portal hypertension, UGIE may be performed after 12-24 h without harm to the patient, facilitating better initial clinical stabilization/treatment and optimization of resources.
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Affiliation(s)
| | - Silvia Cardoso
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Endoscopy Unit, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Pediatric Surgery Unit Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Ana Cristina Tannuri
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Marcela Preto-Zamperlini
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Cláudio Schvartsman
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Sylvia Costa Lima Farhat
- Emergency Department, Children's Institute, Faculdade de Medicina da Universidade de Sao Paulo, Brazil.
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Giorno EPC, De Paulis M, Sameshima YT, Weerdenburg K, Savoia P, Nanbu DY, Couto TB, Sa FVM, Farhat SCL, Carvalho WB, Preto-Zamperlini M, Schvartsman C. Point-of-care lung ultrasound imaging in pediatric COVID-19. Ultrasound J 2020; 12:50. [PMID: 33252715 PMCID: PMC7702205 DOI: 10.1186/s13089-020-00198-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There has been limited data regarding the usefulness of lung ultrasound (US) in children with COVID-19. OBJECTIVE To describe lung US imaging findings and aeration score of 34 children with COVID-19. METHODS This study included 0-16-year-old patients with confirmed COVID-19, who were admitted between April 19 and June 18, 2020 in two hospitals in the city of Sao Paulo, Brazil. Lung US was performed as part of the routine evaluation by a skilled Pediatric Emergency physician. Clinical and laboratory data were collected and severity classifications were done according to an available clinical definition. The lung US findings were described for each lung field and a validated ultrasound lung aeration score was calculated. Data obtained was correlated with clinical information and other imaging modalities available for each case. RESULTS Thirty-four confirmed COVID-19 patients had a lung US performed during this period. Eighteen (18/34) had abnormalities on the lung US, but eight of them (8/18) had a normal chest radiograph. Ultrasound lung aeration score medians for severe/critical, moderate, and mild disease were 17.5 (2-30), 4 (range 0-14), 0 (range 0-15), respectively (p = 0.001). Twelve patients (12/34) also had a chest computed tomography (CT) performed; both the findings and topography of lung compromise on the CT were consistent with the information obtained by lung US. CONCLUSION Point-of-care lung US may have a key role in assessing lung injury in children with COVID-19.
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Affiliation(s)
- Eliana P C Giorno
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil.
| | - Milena De Paulis
- Emergency Department, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil
- Emergency Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | - Kirstin Weerdenburg
- Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Paulo Savoia
- Radiology Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Radiology Department, Radiology Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Danilo Y Nanbu
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
- Emergency Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Thomaz B Couto
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
| | - Fernanda V M Sa
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
- Emergency Department, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Sylvia C L Farhat
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
| | - Werther B Carvalho
- Pediatric Intensive Care, Children's Institute, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcela Preto-Zamperlini
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
| | - Claudio Schvartsman
- Emergency Department, Instituto da Criança da FMUSP, University of Sao Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, Cerqueira César, Sao Paulo, SP, CEP-05403.000, Brazil
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Paes de Castro Giorno E, Preto-Zamperlini M, Weerdenburg K, de Siqueira Ferraz I, Marques Leite M, Costa Lima Farhat S, Schvartsman C. Point-Of-Care Ultrasound for Lung Assessment in Patients With Severe Scoliosis and Chest Deformities: An Emergency Department Case Series. J Emerg Med 2020; 58:775-780. [PMID: 32247661 DOI: 10.1016/j.jemermed.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/22/2020] [Accepted: 02/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diagnosing pneumonia and other lung conditions can be challenging in patients with severe intellectual or physical disabilities or severe chest deformities. Physical examination is sometimes difficult to perform and the frequently requested chest x-ray (CXR) study is often of little value in the diagnostic approach to this population. Point-of-care lung ultrasound (US) is an emerging diagnostic tool with particularly high level of accuracy in detecting pneumonia, pleural effusion, and pneumothorax. CASE REPORT This case series describes four cases demonstrating the usefulness of point-of-care US in a pediatric emergency department for lung assessment in patients for differentiation and diagnosis of acute causes of acute respiratory symptoms, in whom clinical features or CXR failed to confirm or exclude pulmonary complications. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In patients with chest deformities, pulmonary complications can be disproportionately frequent. Lung US should be recognized as an important adjunctive tool in this subset of patients to detect pneumonia, pleural effusions, and pneumothorax. When used proactively, it can reduce unnecessary radiation exposure, provide more certainty in determining the diagnosis, and, most importantly, inform correct and timely management.
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Affiliation(s)
| | - Marcela Preto-Zamperlini
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Kirstin Weerdenburg
- Department of Pediatric Emergency Medicine IWK Health Center and Dalhousie University, Halifax, Nova Scotia, Canada; IWK Health Center, Halifax, Nova Scotia, Canada
| | - Isabel de Siqueira Ferraz
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcia Marques Leite
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Sylvia Costa Lima Farhat
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Claudio Schvartsman
- Emergency Department, Children's Institute, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Dean, Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), São Paulo, Brazil
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Preto-Zamperlini M, Weerdenburg K, Zamperlini-Netto G, Fischer JW. Point-of-Care Ultrasound Findings Associated With Langerhans Cell Histiocytosis in the Pediatric Emergency Department. J Ultrasound Med 2016; 35:449-451. [PMID: 26782161 DOI: 10.7863/ultra.15.05030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/11/2015] [Indexed: 06/05/2023]
Abstract
Langerhans cell histiocytosis is a rare disease characterized by clonal proliferation of Langerhans-type cells, causing local or systemic effects. One of the most affected sites in children is the skull. We describe 2 cases of children presenting to the pediatric emergency department with symptoms isolated to the scalp and the point-of-care focused skull ultrasound findings, which assisted in the diagnosis of Langerhans cell histiocytosis in both cases.
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Affiliation(s)
- Marcela Preto-Zamperlini
- Departments of Emergency Medicine (M.P.-Z.) and Pediatric Oncology and Hematology (G.Z.-N.), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; and Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (K.W., J.W.F.).
| | - Kirstin Weerdenburg
- Departments of Emergency Medicine (M.P.-Z.) and Pediatric Oncology and Hematology (G.Z.-N.), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; and Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (K.W., J.W.F.)
| | - Gabriele Zamperlini-Netto
- Departments of Emergency Medicine (M.P.-Z.) and Pediatric Oncology and Hematology (G.Z.-N.), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; and Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (K.W., J.W.F.)
| | - Jason W Fischer
- Departments of Emergency Medicine (M.P.-Z.) and Pediatric Oncology and Hematology (G.Z.-N.), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; and Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada (K.W., J.W.F.)
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Schuh S, Chan K, Langer JC, Kulik D, Preto-Zamperlini M, Aswad NA, Man C, Mohanta A, Stephens D, Doria AS. Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use. Acad Emerg Med 2015; 22:406-14. [PMID: 25808065 DOI: 10.1111/acem.12631] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/24/2014] [Accepted: 11/26/2014] [Indexed: 12/16/2022]
Abstract
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. This pathway consisted of an initial US followed by a clinical reassessment in each patient and an interval US and surgical consultation in patients with equivocal initial US and persistent concern about appendicitis. The USs were interpreted by published criteria as positive, negative, or equivocal for appendicitis. Children in whom this pathway did not rule in or rule out appendicitis underwent computed tomography (CT). Cases with missed appendicitis, negative operations, and CTs after the pathway were considered inaccurate. The primary outcome was the diagnostic accuracy of the serial US clinical diagnostic pathway. The secondary outcomes included the test performance of the initial and interval US imaging studies. RESULTS Of the 294 study children, 111 (38%) had appendicitis. Using the serial US clinical diagnostic pathway, 274 of 294 children (93%, 95% confidence interval [CI] = 90% to 96%) had diagnostically accurate results: 108 of the 111 (97%) appendicitis cases were successfully identified by the pathway without CT scans (two missed and one CT), and 166 of the 183 (91%) negative cases were ruled out without CT scans (14 negative operations and three CTs). The sensitivity of this pathway was 108 of 111 (97%, 95% CI = 94% to 100%), specificity 166 of 183 (91%, 95% CI = 87% to 95%), positive predictive value 108 of 125 (86%; 95% CI = 79% to 92%), and negative predictive value 166 of 169 (98%, 95% CI = 96% to 100%). The diagnostic accuracy of the pathway was higher than that of the initial US alone (274 of 294 vs. 160 of 294; p < 0.0001). Of 123 patients with equivocal initial US, concern about appendicitis subsided on clinical reassessment in 73 (no surgery and no missed appendicitis). Of 50 children with persistent symptoms, 40 underwent interval US and 10 had surgical consultation alone. The interval US confirmed or ruled out appendicitis in 22 of 40 children (55.0%) with equivocal initial US, with one false-positive interval US. CONCLUSIONS The serial US clinical diagnostic pathway in suspected appendicitis has an acceptable diagnostic accuracy that is significantly higher than that of the initial US and results in few CT scans. This approach appears most useful in children with equivocal initial US, in whom the majority of negative cases were identified at clinical reassessment and appendicitis was diagnosed by interval US or surgical consultation in most study patients.
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Affiliation(s)
- Suzanne Schuh
- Division of Pediatric Emergency Medicine; University of Toronto; Toronto Ontario Canada
- Department of Pediatrics; University of Toronto; Toronto Ontario Canada
- Research Institute; University of Toronto; Toronto Ontario Canada
| | - Kevin Chan
- Division of Pediatric Emergency Medicine; University of Toronto; Toronto Ontario Canada
| | - Jacob C. Langer
- Department of Surgery; University of Toronto; Toronto Ontario Canada
| | - Dina Kulik
- Division of Pediatric Emergency Medicine; University of Toronto; Toronto Ontario Canada
| | | | - Nadine Al Aswad
- Division of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - Carina Man
- Division of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - Arun Mohanta
- Division of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | - Derek Stephens
- Research Institute; University of Toronto; Toronto Ontario Canada
| | - Andrea S. Doria
- Division of Diagnostic Imaging; The Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
- Research Institute; University of Toronto; Toronto Ontario Canada
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