Appendicitis tests in children

22 March, 2013 by: colinparker

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It seems that this one slipped under the radar, when we originally published it… Because I followed it with a tongue-in-cheek summary post about the (lack of) utility of tests for appendicitis, and did not leave enough of a gap between the two posts, iTunes only picked up the abbreviated jokey version, leaving the original PEMcast undiscovered by many…

So here it is again, for the benefit of our loyal followers on iTunes.
The original post, which is surprisingly similar, can be found here:

Outline: Tests for Appendicitis

[CP] hello, disclaimer, introduction

Review Article:

Bundy 2007 JAMA “Does this child have appendicitis?”
[CP] overview (including methods)

[KB] appendicitis symptoms

[SF] appendicitis signs

[CP] results: symptoms

[KB] results: signs

[SF] results: WBC count & differential

[CP] results: CRP & ESR

[ALL] comments re blood tests especially WBC

Passing mention of O’Shea 1988 Pediatric Emergency Care

[CP] Scoring systems: Alvarado Score (still with reference to Bundy)

[CP] Alvarado 1986 Annals of Emergency Medicine

[SF] Scoring systems: (Samuel) Paediatric Appendicitis Score (still with reference to Bundy)

[SF] Samuel 2002 J Pediatric Surgery

[KB] Scoring systems: Low-Risk decision rule: (with reference to Bundy)

[KB] Kharbanda 2005 Pediatrics

Passing mention of Schneider 2007 (Annals of Emergency Medicine) prospective evaluation of scoring systems.
(still with reference to Bundy):

[SF] Clinical gestalt (as indicated by imaging ordered)

[CP] Comparison with Adult data

[KB] Limitations in the Literature

Imaging Tests for suspected appendicitis

[CP] introduction (rule-out vs rule-in strategies, unnecessary when diagnosis obviously appendicitis or obviously not)

[KB] UltraSound with Graded Compression – Sim 1989 J National Med Association

[SF] CT for Appendicitis: Callahan 2002 Radiology

[CP] Contrast or not: Kaiser 2004 Radiology

[SF] An Argument for Ultrasound: Strouse 2010 Radiology

[KB] Routine Ultrasound & Limited CT: Toorenvliet 2010 World J Surgery

[ALL] Comments re: Imaging in suspected appendicitis
(where does Australia sit on the UK – USA spectrum – U/S vs CT?)

What’s new?

[SF] calprotectin (S100A8/A9): Bealer & Colgin 2010 Academic Emergency Medicine – featured in Journal Watch top 10 most read articles in EM in 2010

Bottom Line

[KB] Acheson & Banerjee 2010 Arch Dis Child Education & Practice Edition

[ALL] When to do blood tests?

[ALL] When to get imaging?

[ALL] When to get Surgical review?

[ALL] Discharge advice – when appendicitis unlikely but not excluded

[CP] Summary, goodbye


Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE.
Does this child have appendicitis?
JAMA. 2007 Jul 25;298(4):438-51. Review.
PubMed PMID: 17652298; PubMed Central PMCID: PMC2703737.

O’Shea JS, Bishop ME, Alario AJ, Cooper JM.
Diagnosing appendicitis in children with acute abdominal pain.
Pediatr Emerg Care. 1988 Sep;4(3):172-6.
PubMed PMID: 3186519.

Alvarado A.
A practical score for the early diagnosis of acute appendicitis.
Ann Emerg Med. 1986 May;15(5):557-64.
PubMed PMID: 3963537.

Samuel M.
Pediatric appendicitis score.
J Pediatr Surg. 2002 Jun;37(6):877-81.
PubMed PMID: 12037754.

Kharbanda AB, Taylor GA, Fishman SJ, Bachur RG.
A clinical decision rule to identify children at low risk for appendicitis.
Pediatrics. 2005 Sep;116(3):709-16.
PubMed PMID: 16140712.

Schneider C, Kharbanda A, Bachur R.
Evaluating appendicitis scoring systems using a prospective pediatric cohort.
Ann Emerg Med. 2007 Jun;49(6):778-84, 784.e1. Epub 2007 Mar 26.
PubMed PMID: 17383771.

Sim KT, Picone S, Crade M, Sweeney JP.
Ultrasound with graded compression in the evaluation of acute appendicitis.
J Natl Med Assoc. 1989 Sep;81(9):954-7. Review.
PubMed PMID: 2674464; PubMed Central PMCID: PMC2626073.

Callahan MJ, Rodriguez DP, Taylor GA.
CT of appendicitis in children.
Radiology. 2002 Aug;224(2):325-32.
PubMed PMID: 12147823.

Kaiser S, Finnbogason T, Jorulf HK, Söderman E, Frenckner B.
Suspected appendicitis in children: diagnosis with contrast-enhanced versus nonenhanced Helical CT.
Radiology. 2004 May;231(2):427-33. Epub 2004 Mar 18.
PubMed PMID: 15031433.

Strouse PJ.
Pediatric appendicitis: an argument for US.
Radiology. 2010 Apr;255(1):8-13. doi: 10.1148/radiol.10091198.
PubMed PMID: 20308438.

Toorenvliet BR, Wiersma F, Bakker RF, Merkus JW, Breslau PJ, Hamming JF.
Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis.
World J Surg. 2010 Oct;34(10):2278-85. doi: 10.1007/s00268-010-0694-y.
PubMed PMID: 20582544; PubMed Central PMCID: PMC2936677.

Bealer JF, Colgin M.
S100A8/A9: a potential new diagnostic aid for acute appendicitis.
Acad Emerg Med. 2010 Mar;17(3):333-6. doi: 10.1111/j.1553-2712.2010.00663.x.
PubMed PMID: 20370768.

Acheson J, Banerjee J.
Management of suspected appendicitis in children.
Arch Dis Child Educ Pract Ed. 2010 Feb;95(1):9-13. doi: 10.1136/adc.2009.168468.
PubMed PMID: 20145013.

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