EVALUATION OF BEDSIDE SONOGRAPHY PERFORMED BY EMERGENCY PHYSICIANS TO DETECT ACUTE APPENDICITIS IN CHILDREN IN THE EMERGENCY DEPARTMENT
Notice bibliographique
Résumé
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). DESIGN/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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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,001 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».