Evaluation of bedside sonography performed by emergency physicians to detect acute appendicitis in children in the emergency department.
CPS ePoster Library. Desjardins M. Jun 1, 2017; 176586; 25
Dr. Marie Pier Desjardins
Dr. Marie Pier Desjardins
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Abstract
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Background: Previous studies suggested that emergency physicians (EPs) highly experienced in point-of-care ultrasound (POCUS) have similar performance to formal ultrasound to identify appendicitis in children.

Objectives: The aim of our study was to evaluate the ability of EPs with various levels of POCUS experience to detect appendicitis with POCUS among children visiting a pediatric emergency department (ED).

Methods: A prospective cohort study was conducted in an urban, tertiary care pediatric ED, after being accepted by the ethics committee. The study population was children aged 2 to 18 years old presenting to the ED with acute abdominal pain suggesting appendicitis. Patients were excluded if they had a history of appendectomy, instability requiring resuscitation, or were transferred with proven diagnosis of appendicitis. Participating physicians were experienced in pediatric emergency medicine but had various levels of POCUS experience. They received a 1-hour didactical and practical training session on appendix ultrasound. All POCUS were performed by the treating physician before further radiological evaluation following initial physical exam. Final outcomes were determined by pathology and/or operative reports for surgical cases, and telephone follow-up at 3 weeks for those who did not have surgery. The primary analysis was a simple proportion for sensitivity and specificity for POCUS. Expecting a sensibility of 80% based on previous studies, we calculated that a sample size of 50 cases would provide a 95% CI ranging from 66 to 90%.

Results: We approached 140 patients, from which 121 were recruited. After 4 exclusions for missing data, 117 patients were included for the primary analysis, of which 51 (44%) had appendicitis. Twenty-two EPs performed between 1 and 20 POCUS. The POCUS identified 27 out of 51 appendicitis for a sensitivity of 0.53 (95% CI: 0.40-0.66). A normal or inconclusive POCUS was reported for 54 out of 66 patients without appendicitis (specificity of 0.74; 95%CI: 0.60-0.84). EPs took a mean time of 3,53 minutes to perform POC US.

Conclusion: This study shows poor sensitivity and limited specificity of POCUS for appendicitis in children. Our specificity is lower that most previous studies, but probably more representative of the limited ability of the majority of EPs to diagnose appendicitis with POCUS.

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