Is Abdominal Sonography a Useful Adjunct to Abdominal Radiography in Evaluating Neonates with Suspected Necrotizing Enterocolitis?
| Autor: | Stefanie P. Lazow, Richard B. Parad, Judy A. Estroff, David Zurakowski, Ilse Castro-Aragon, Sarah A. Tracy, Catherine Chen, Alan M. Fujii, Steven J. Staffa |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Radiography Abdominal medicine.medical_specialty Radiography Concordance 03 medical and health sciences 0302 clinical medicine Pneumoperitoneum Enterocolitis Necrotizing Predictive Value of Tests medicine Humans Retrospective Studies Ultrasonography Enterocolitis medicine.diagnostic_test business.industry Infant Newborn Reproducibility of Results Retrospective cohort study medicine.disease 030220 oncology & carcinogenesis Abdominal ultrasonography Predictive value of tests Necrotizing enterocolitis 030211 gastroenterology & hepatology Surgery Female Radiology medicine.symptom business |
| Zdroj: | Journal of the American College of Surgeons. 230(6) |
| ISSN: | 1879-1190 |
| Popis: | Background Abdominal sonography (AUS) is emerging as a potentially valuable adjunct to conventional abdominal radiography (AXR) in the setting of suspected necrotizing enterocolitis (NEC). We sought to evaluate concordance between AUS and AXR for signs of NEC to better understand the potential advantages and disadvantages of AUS. As a secondary aim, we characterized AUS-specific findings and evaluated the association of imaging results with clinical outcomes. Study Design Hospitalized infants with clinical concern for NEC from 2009 to 2018 were included in this multicenter retrospective review. All infant patients had at least 1 paired AXR followed by an AUS within 24 hours. Findings were abstracted from written radiology reports. Cohen’s κ, nonparametric Mann-Whitney U test, and quantile regression were used to evaluate chance-corrected levels of agreement for concordance analyses and associations with clinical outcomes. Results In total, 66 patients and 96 paired studies were evaluated. Agreement between the 2 imaging modalities was 61 of 96 (63.5%) for pneumatosis (κ = 0.29; 95% CI, 0.10 to 0.48), 79 of 96 (82.3%) for portal venous gas (κ = 0.07; 95% CI, 0.00 to 0.47), and 91 of 96 (94.8%) for pneumoperitoneum (κ = 0.52; 95% CI, 0.11 to 0.93). Each finding was present more frequently on AUS than AXR. On AUS, pneumatosis and focal fluid collection were independently associated with a longer antibiotic course (4.1 days longer; p = 0.03 and 21.3 days longer; p Conclusions AUS holds promise as a useful adjunct to radiography for neonates with possible NEC. It might be more sensitive for the presence or absence of bowel ischemia and can reveal findings not detectable by radiography, which can aid provider decision-making. |
| Databáze: | OpenAIRE |
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