Diagnostic Algorithm in the Pediatric Appendicitis; A Prospective Clinical Study

Abstract

Aim: We compare the diagnostic approaches: surgeon prediction, surgeon prediction plus ultrasound imagining (US) as the first-line imaging modality, and magnetic resonance imagining (MRI) as the second-line imaging for suspected pediatric appendicitis. Methods: Three hundred sixty-one patients with a clinically suspected appendicitis were prospectively divided into three groups by the type of diagnostic approach. Results: A total of 51 patients were diagnosed via only the surgeon prediction. Of the patients, 254 only underwent a US examination, and 56 patients underwent both US and MRI. Considering the diagnostic groups, the accuracy of both the “surgeon prediction only” and “surgeon prediction + US + MRI” groups was 100%. The “surgeon prediction + US” group revealed a sensitivity value of 62,4% with an accuracy rate of 59,8%. The sensitivity and specificity of US were 61,0%, 65,5%, respectively. These values were 100% for MRI. The sensitivity, specificity of our institutional algorithm were 100,0%, 94,4%, and the positive-negative predictive values were 94,7%, 100%. Conclusions: To diagnose appendicitis in children, surgeon’s assessment, prudence, and clinical evaluation should be the first method of diagnosis. US is a useful method to support surgeons in ensuring an accurate diagnosis, and MRI can be trusted as an additional method to verify a correct diagnosis.

Keywords

• acute apandicitis
• children
• magnetic resonance imagining
• ultrasound

Çocuklarda Apandisit Tanı Algoritması; Prospektif Klinik Çalışma

Abstract

Amaç: Akut apandisit (AA), çocuklarda tanısı birçok hastalıkla karışabilmektedir. Bu da gecikmiş tedaviye neden olmaktadır. Görüntüleme yöntemleri hekimlere tanıda yardımcı olabilmektedir. Çalışmamızda AA tanısını koymada yaklaşımlar neler olabiliri değerlendiriyoruz. Tanısal yaklaşımları üç gruba ayırdık. Bunlar: birinci basamakta sadece cerrahın muayenesi, ikinci basamak olarak cerrahın muayenesi ile birlikte Ultrason (US), üçüncü basamakta da şüpheli kalınan durumlarda Manyetik rezonans görüntülemenin (MRG) kullanılmasıydı. Yöntem: Klinik olarak apandisit şüphesi olan üç yüz altmış bir hasta, tanısal yaklaşım tipine göre prospektif olarak üç gruba ayrıldı. Bulgular: Toplam 51 hastaya sadece cerrah öngörüsü ile tanı konuldu. Hastaların 254'üne sadece US incelemesi yapıldı ve 56 hastaya hem US hem de MRG yapıldı. Tanı grupları dikkate alındığında hem “sadece cerrahın muayenesi” hem de “Cerrahın muayenesi + US + MRI” gruplarının doğruluğu %100 idi. “Cerrahın muayenesi + US” grubu, %59,8 doğruluk oranı ile %62,4'lük bir duyarlılık değeri ortaya koydu. US'nun duyarlılığı ve özgüllüğü sırasıyla %61,0, %65,5 idi. Bu değerler MRG için %100 idi. Kurumsal algoritmamızın duyarlılığı, özgüllüğü %100,0, %94,4, pozitif-negatif tahmin değerleri %94,7, %100 idi. Sonuç: Çocuklarda apandisit tanısı için cerrahın değerlendirmesi ve klinik değerlendirmesi ilk tanı yöntemi olmalıdır. US, cerrahları doğru tanı koymada desteklemek için yararlı bir yöntemdir ve MRG, doğru tanıyı doğrulamak için ek bir yöntem olarak güvenilir olabilir.

Keywords

• akut apandisit
• çocuk
• manyetik rezonans görüntüleme
• ultrasonografi

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