Is a pediatrician performed gray scale ultrasonography with power Doppler study safe and effective for triaging acute non-perforated appendicitis for conservative management?

Abstract Purpose The purpose of this study was to examine whether acute non-perforated appendicitis (ANPA) can be safely triaged by a pediatrician for conservative management (CM) using gray-scale ultrasonography with power Doppler (GSPD). Method 75 cases of ANPA assessed by a pediatrician with GSPD...

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Bibliographic Details
Published in:Journal of pediatric surgery 2016-12, Vol.51 (12), p.1952-1956
Main Authors: Jimbo, Keisuke, Takeda, Masahiro, Miyata, Eri, Murakami, Hiroshi, Kyodo, Reiko, Orikasa, Hideki, Lane, Geoffrey J, Shimizu, Toshiaki, Yamataka, Atsuyuki
Format: Article
Language:English
Subjects:
Acute Disease
Acute non-perforated appendicitis
Adolescent
Appendicitis - diagnostic imaging
Appendicitis - therapy
Child
Child, Preschool
Conservative management
Conservative Treatment
Emergency appendectomy
Female
Humans
Interval appendectomy
Male
Pediatricians
Pediatrics
Power Doppler study
Retrospective Studies
Surgery
Triage - methods
Ultrasonography, Doppler, Duplex - methods
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Summary:Abstract Purpose The purpose of this study was to examine whether acute non-perforated appendicitis (ANPA) can be safely triaged by a pediatrician for conservative management (CM) using gray-scale ultrasonography with power Doppler (GSPD). Method 75 cases of ANPA assessed by a pediatrician with GSPD (2013–2015) were reviewed. GSPD grading for ANPA was: I: slightly irregular wall/normal blood flow; II: irregular wall/increased blood flow; III: irregular wall/decreased blood flow; and IV: absence of wall/blood flow. Grades I/II were managed conservatively with intravenous antibiotics then encouraged to book for interval appendectomy (IA). Grades III/ IV were reviewed for emergency appendectomy (EA) by a pediatric surgeon. Results GSPD grading was I (n = 26), II (n = 36), III (n = 9), and IV (n = 4). EA was required for 5 cases, one grade III, and four grade IV cases. One grade IV case was treated conservatively after surgical review but EA was unavoidable. Of the remaining 70 cases discharged well after a mean of 5.7 days hospitalization, 25/70 had IA with chronic inflammation on histology, 6/70 had recurrence of ANPA treated successfully by EA, and 39/70 remain asymptomatic at least 10 months after declining IA. Overall, GSPD triaging with CM was cheaper than surgery. Conclusions GSPD performed by pediatricians appears to be safe/effective for triaging ANPA. Diagnostic Study – Level III
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2016.09.018