Abstract:
PURPOSE:In October 2000, our institution implemented a clinical practice guideline (CPG) utilizing selective computed tomography (CT) and ultrasound scan (US) for the evaluation of children with suspected appendicitis. The authors sought to determine surgical outcomes and diagnostic accuracy in the CPG period. METHODS:The authors retrospectively analyzed the medical records of patients evaluated under the CPG at their institution between January 1 and December 31, 2001. Depending on a patient's clinical presentation, the CPG recommends immediate surgery or further evaluation with CT or US. CPG patients were identified if they received an appendectomy or a CT or US for suspected appendicitis. Negative appendectomy and perforation rates, as well as admissions for inpatient observation were compared with control patients treated for suspected appendicitis at our hospital in 1997, before frequent utilization of imaging studies. RESULTS:In the CPG period, 571 patients were evaluated for acute appendicitis, with 272 undergoing an appendectomy. Whereas 513 patients (90%) received a CT or US, only 34 patients (6%) were admitted to the surgical service for serial examinations. Patients with a histologically normal appendix decreased from 27 of 255 (10.6%) in 1997 to 15 of 272 (5.5%) in 2001 (P =.03). Fifty-seven patients (22.2%) in 2001 had a perforated appendix compared with 65 (28.5%) in 1997 (P =.11). The CPG, incorporating clinical judgment and selected imaging, had a sensitivity of 98.8%, a specificity of 95.2%, and positive and negative predictive values of 94.4% and 99.0%, respectively. CONCLUSIONS:A clinical practice guideline selectively utilizing CT and US is highly accurate in the diagnosis of acute appendicitis, minimizing the need for inpatient admission for serial examinations.
journal_name
J Pediatr Surgjournal_title
Journal of pediatric surgeryauthors
Smink DS,Finkelstein JA,Garcia Peña BM,Shannon MW,Taylor GA,Fishman SJdoi
10.1016/j.jpedsurg.2003.11.015subject
Has Abstractpub_date
2004-03-01 00:00:00pages
458-63; discussion 458-63issue
3eissn
0022-3468issn
1531-5037pii
S002234680300873Xjournal_volume
39pub_type
杂志文章abstract:BACKGROUND:The management of malrotation in patients with congenital abdominal wall defects has varied among surgeons. We were interested in investigating the risk of midgut volvulus in patients with gastroschisis and omphalocele to help determine if these patients may benefit from undergoing a Ladd procedure. METHODS...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,多中心研究
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abstract::Persistence and dilation of the embryologic thyroglossal tract gives rise to the condition of thyroglossal duct cyst. Although these cysts have an embryologic origin, there is rarely a history of inheritance. A search of the literature shows only two family reports, which includes a total of nine patients. We report o...
journal_title:Journal of pediatric surgery
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abstract:PURPOSE:Perineal groove is a rare congenital anomaly of the perineum, and only a few papers describing a small number of cases have been reported in the medical literature. This study aimed to evaluate the clinical characteristics and proper management of perineal groove. METHODS:We performed a retrospective review of...
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abstract::The purpose of this study was to analyze the preliminary results obtained with endoscopic treatment of children with chronic idiopathic pancreatitis. The disease appears to be caused by a deficit of pancreatic stabilizing proteins that leads to precipitation of solutes contained in the pancreatic secretions; these pre...
journal_title:Journal of pediatric surgery
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doi:10.1016/s0022-3468(96)90837-4
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abstract:BACKGROUND:Pediatric inguinal hernia repair is the most common operation performed by surgeons. During open operation, rupture and retraction of the hernia sac may occur. Also, dislodgement of suture ligature or clamps may allow sac retraction into the abdominal cavity. In these situations, relegation of the retracting...
journal_title:Journal of pediatric surgery
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abstract:OBJECTIVE:To evaluate the efficacy of laparoscopic pneumovesical ureter reimplantation for congenital malformation involving the vesicoureteral junction in children. METHODS:From January 2005 to October 2010, 45 cases (comprising 61 ureters) were diagnosed as megaureter caused by vesicoureteral junction obstruction. A...
journal_title:Journal of pediatric surgery
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abstract::The existence of Helicobacter pylori (HP) infection in those children who had previous bladder augmentation with gastric patch has not been described before. In this report, a girl with bladder exstrophy, who previously underwent gastric augmentation is presented. She had multiple admissions to our unit with persistin...
journal_title:Journal of pediatric surgery
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abstract::The feasibility of the use of indium 111 oxine-labeled autologous leukocytes for the diagnosis of ischemic enterocolitis in vivo was examined in an experimental model of ischemia in dogs. A 30-cm segment of small intestine was devascularized by ligating the arteries and veins from the last arcade in 7 dogs. A sham ope...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(91)90669-k
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abstract::Amputation remains the standard surgical management for patients with osteosarcoma. However, in carefully selected patients, eradication of the primary tumor can be achieved by En-Bloc resection of the affected bone preserving both anatomical and functional status. Our criteria for limb salvage procedures are that pat...
journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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abstract::In addition to pulmonary hypoplasia and an altered pulmonary vascular bed, the abnormal lung development caused by congenital diaphragmatic hernia (CDH) is associated with an impairment in the pulmonary surfactant system. The aim of this study was to correlate fetal serum cortisol and triiodothyronine (T3) levels, kno...
journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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更新日期:2020-03-01 00:00:00
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journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2017.03.032
更新日期:2017-06-01 00:00:00
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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journal_title:Journal of pediatric surgery
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abstract::Between January 1, 1969, and February 2, 1988, 331 pediatric renal transplants were performed at a single pediatric center. Of these 225 were first cadaveric allografts. Graft allocation was independent of the outcome of human lymphocyte antigen (HLA) matching. The results of class I antigen matching were analyzed in ...
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