Diagnostic Performance of Ultrasonography for Pediatric Appendicitis
| Autor: | V.S. Mangona, Monica E. Lopez, Wei Zhang, Jennifer M. Carpenter, Kate Louise M. Mangona, R. Paul Guillerman, Robert C. Orth |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.disease Appendicitis Appendix 030218 nuclear medicine & medical imaging 03 medical and health sciences symbols.namesake 0302 clinical medicine medicine.anatomical_structure Cohen's kappa 030220 oncology & carcinogenesis False positive paradox symbols Medicine Radiology Nuclear Medicine and imaging Pediatric appendicitis Radiology Medical diagnosis Ultrasonography business Fisher's exact test |
| Zdroj: | Academic Radiology. 24:1616-1620 |
| ISSN: | 1076-6332 |
| DOI: | 10.1016/j.acra.2017.06.007 |
| Popis: | Rationale and Objectives For imaging pediatric appendicitis, ultrasonography (US) is preferred because of its lack of ionizing radiation, but is limited by operator dependence. This study investigates the US diagnostic performance during night shifts covered by radiology trainees compared to day shifts covered by attending radiologists. Materials and Methods Appy-Scores (1 = completely visualized normal appendix; 2 = partially visualized normal appendix; 3 = nonvisualized appendix with no inflammatory changes in the expected region of the appendix; 4 = equivocal; 5a = nonperforated appendicitis; 5b = perforated appendicitis) from 2935 US examinations (2161:774, day-to-night) from July 2013 to 2014 were correlated with the intraoperative diagnoses and the clinical follow-up. The diagnostic performance of trainees and attendings was compared with Fisher exact test. Interobserver agreement was measured by Cohen kappa coefficient. Results Appendicitis prevalence was 25.3% (day) and 22.5% (night). Sensitivity, specificity, accuracy, negative predictive value, and positive predictive vale were 94.0%, 93.7%, 93.8%, 97.9%, and 83.4% during the day and 92.0%, 91.2%, 91.3%, 97.5%, and 75.2% at night. Specificity (P = .048) and positive predictive value (P = .011) differed, with more false positives at night (7%) than during the day (4.7%). Trainee and attending agreement was high (k = 0.995), with Appy-Scores of 1, 4, and 5a most frequently discordant. Conclusions US has a high diagnostic performance and interobserver agreement for pediatric appendicitis when interpreted by radiology trainees during night shifts or attending radiologists during day shifts. However, lower specificity and positive predictive value at night warrants a thorough trainee education to avoid false-positive examinations. |
| Databáze: | OpenAIRE |
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