Determining the impact of body mass index on ultrasound accuracy for diagnosing appendicitis: Is it less useful in obese children?

Autor: Tantisook T; School of Medicine, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, United States; Department of Emergency Medicine, University of Florida, Jacksonville, FL, United States., Aravapalli S; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, United States; Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, United States., Chotai PN; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, United States; Department of General Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, United States., Majmudar A; Department of Radiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, United States; Department of Radiology, SUNY Upstate Medical Center, Syracuse, NY., Meredith M; Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, United States., Harrell C; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, United States., Cohen HL; Department of Radiology, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, United States., Huang EY; Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, TN, United States; Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, United States. Electronic address: eunice.huang@vumc.org.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2021 Nov; Vol. 56 (11), pp. 2010-2015. Date of Electronic Publication: 2021 Jan 30.
DOI: 10.1016/j.jpedsurg.2021.01.023
Abstrakt: Background: Ultrasonography (US) is the preferred imaging for suspected pediatric appendicitis. We hypothesize that children with elevated Body-Mass-Index-for-age percentile (BMIP) may be more likely to have an inaccurate or equivocal (IE) US.
Methods: After IRB approval, a four-year review was performed on pediatric patients evaluated for appendicitis by US. The CDC BMIP Calculator was used. IE subgroups were analyzed together for comparison against the accurate group.
Results: 1059 patients were included: median age 11.3 years (IQR: 8.2, 14.6), 506 (47.8%) males. Median BMIP was 65.9 (IQR: 33.9, 89.6). US accurately diagnosed 857 (80.9%), incorrectly diagnosed 76 (7.2%), 126 (11.9%) were equivocal. Overall sensitivity was 0.85, specificity 0.96, PPV 0.93 and NPV 0.91. Obese children (BMIP ≥95%), had higher odds of IE US (OR: 1.86, 95% CI: 1.28, 2.70; p = 0.001). When analyzed by sex, risk increased in obese males (OR: 2.55, 95% CI:1.53, 4.24; p = 0.0003) but normalized in obese females (OR: 1.30, 95% CI:0.74, 2.28; p = 0.35).
Conclusions: An elevated BMIP may increase difficulty in visualizing the appendix, resulting in inaccurate or equivocal findings. This risk is seen specifically in obese males. If US findings do not correlate with clinical assessment in obese children with abdominal pain, further evaluation may be warranted.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE