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2.
Acad Emerg Med ; 23(2): 179-85, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26765503

ABSTRACT

OBJECTIVES: Suggestive radiographic studies with nonvisualization of the appendix can present a challenge to clinicians in the evaluation of pediatric abdominal pain. The primary objective of this study was to quantify the accuracy of magnetic resonance imaging (MRI) and of ultrasound (US) in the setting of nonvisualization of the appendix. Secondary objectives reported include sensitivity of MRI and US overall and correlation between MRI and US for diagnosis of appendicitis. METHODS: Records of pediatric emergency department patients aged 3 to 21 years undergoing MRI and/or US for the evaluation of appendicitis were retrospectively reviewed. Radiographs were categorized as a normal appendix, neither demonstrating the appendix nor demonstrating abnormalities consistent with appendicitis; equivocal, not demonstrating the appendix but showing evidence of appendicitis; demonstrating an abnormal appendix consistent with appendicitis; or demonstrating an alternate pathology. The reading was compared with the final diagnosis for accuracy. RESULTS: Of the 589 patients included, 146 had appendicitis. Diagnostic accuracy for studies with a nonvisualized appendix without secondary signs of appendicitis was 100% for MRI and 91.4% (95% CI = 87.3% to 94.2%) for US. Diagnostic accuracy for studies with a nonvisualized appendix with secondary signs of appendicitis was 50% (95% CI = 2.5% to 97.5%) for MRI and 38.9% (95% CI = 18.2% to 64.5%) for US. Appendicitis was ultimately diagnosed in 8.6% of patients with an otherwise negative right lower quadrant (RLQ) US that failed to directly identify the appendix. There was a moderate correlation between US and MRI (ρ = 0.573, p = 0.0001) when all studies were considered. CONCLUSIONS: Magnetic resonance imaging without secondary signs of appendicitis is effective in excluding appendicitis regardless of whether the appendix is directly visualized, while otherwise negative RLQ US that fail to identify the appendix are less useful. Secondary signs of appendicitis without visualization of the appendix were not helpful regardless of radiographic modality. Results of MRI and US correlated moderately well.


Subject(s)
Abdominal Pain/etiology , Appendicitis/diagnosis , Emergency Service, Hospital , Magnetic Resonance Imaging/standards , Ultrasonography/standards , Adolescent , Appendix/diagnostic imaging , Child , Female , Humans , Male , Physical Examination , Predictive Value of Tests , Radiography , Retrospective Studies
3.
J Emerg Med ; 50(4): 638-42, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26810020

ABSTRACT

BACKGROUND: Acute appendicitis is the most common cause of acute abdomen in pediatric emergency department (ED) visits, and right lower quadrant abdominal ultrasound (RLQUS) is a valuable diagnostic tool in the clinical approach. The utility of ultrasound in predicting perforation has not been well-defined. OBJECTIVES: We sought to determine the sensitivity of RLQUS to identify perforation in pediatric patients with appendicitis. METHODS: A chart review of all patients 3 to 21 years of age who received a radiographic work-up and who were ultimately diagnosed with perforated appendicitis between 2010 and 2013 at a pediatric ED was conducted. The final read for ultrasonography was compared to either the operative diagnosis, surgical pathology diagnosis, or further imaging results (if the patient was managed nonoperatively). Test characteristics were calculated for the identification of appendicitis and identification of perforation. RESULTS: Of the 539 patients evaluated for appendicitis, 144 (26.7%) patients had appendicitis, and 40 of these (27.8%) were perforated. Thirty-nine had RLQUS performed as part of their evaluation. Of these, 28 had positive findings for appendicitis, and 9 were read as definite or possible perforated appendicitis. The sensitivity of RLQUS for the diagnosis of appendicitis in the group with perforation was 77.1% (95% confidence interval [CI], 59.4-89%) and the sensitivity for diagnosing a perforation was 23.1% (95% CI, 11.1-39.3%). CONCLUSION: There was a low rate of detection of perforation by RLQUS in our pediatric population. If larger studies confirm this, additional imaging should be recommended in patients with a high suspicion of perforation and in whom a diagnosis of perforation would change management.


Subject(s)
Abdomen, Acute/diagnostic imaging , Appendicitis/diagnostic imaging , Intestinal Perforation/diagnostic imaging , Ultrasonography/methods , Abdomen, Acute/surgery , Adolescent , Appendicitis/surgery , Child , Child, Preschool , Diagnosis, Differential , Emergency Service, Hospital , Female , Humans , Intestinal Perforation/surgery , Male , Sensitivity and Specificity , Treatment Outcome , Young Adult
5.
Pediatr Emerg Care ; 28(8): 789-91, 2012 Aug.
Article in English | MEDLINE | ID: mdl-22858753

ABSTRACT

OBJECTIVE: The objective of this study was to determine the yield of diagnostic workup in children presenting with complex febrile seizures. METHODS: We performed a retrospective review of charts of patients who presented to our pediatric emergency department with complex febrile seizures (focal, prolonged, or recurrent). Patients with known seizure disorder, congenital central nervous system malformations, or hydrocephalus were excluded. The charts were reviewed for diagnostic workup. RESULTS: There were 71 eligible encounters (mean age, 1.5 years); 59.2% were males. None of the 71 patients had positive blood or urine cultures; none had abnormal blood count or serum chemistries. Only 1 patient who had a very abnormal presentation in febrile status epilepticus had positive cerebrospinal fluid culture and abnormal brain computed tomography scan and magnetic resonance imaging. CONCLUSIONS: Most patients with complex febrile seizures do not require extensive diagnostic workup.


Subject(s)
Blood Cell Count/statistics & numerical data , Brain/pathology , Seizures, Febrile/etiology , Spinal Puncture/statistics & numerical data , Urinalysis/statistics & numerical data , Emergency Service, Hospital , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Meningoencephalitis/diagnosis , Mycoplasma pneumoniae/isolation & purification , Neurologic Examination , Pneumonia, Mycoplasma/cerebrospinal fluid , Retrospective Studies , Tomography, X-Ray Computed
6.
Pediatr Emerg Care ; 21(7): 415-9, 2005 Jul.
Article in English | MEDLINE | ID: mdl-16027572

ABSTRACT

OBJECTIVE: To compare levalbuterol and racemic albuterol for the treatment of acute exacerbation of asthma in pediatric population. DESIGN: Prospective, double-blind, randomized research trial in a pediatric emergency department of an urban tertiary care hospital. PARTICIPANTS: Children 5 to 21 years with a history of asthma presenting to the emergency department in acute exacerbation. INTERVENTIONS: As per a computer-generated randomization sequence, patients received either 1.25 mg of levalbuterol or albuterol 2.5 mg via nebulization along with ipratropium hydrochloride. Patients received 3 back-to-back treatments as needed every 20 minutes, maximum of 3; 2 mg/kg of oral prednisone was administered to the patients after the second treatment. Baseline respiratory parameters such as oxygen saturations, respiratory rates, and peak flow rates were measured and repeated after every treatment.The decision for further treatments and or hospitalization was made by the treating emergency department physician as per his/her clinical judgement of the respiratory parameters at the end of 3 treatments. RESULTS: Seventy patients completed the study. Most of the patients were in moderate severity of asthma exacerbation. All patients in both groups showed improvement in oxygen saturations, respiratory rates, and peak flow rates. However, no statistically significant difference was observed in the 2 groups regarding the respiratory parameters (P > 0.05). CONCLUSION: Levalbuterol is not more efficacious than racemic albuterol in improving respiratory parameters in children presenting with acute exacerbation of asthma.


Subject(s)
Albuterol/therapeutic use , Asthma/drug therapy , Bronchodilator Agents/therapeutic use , Adolescent , Adult , Asthma/blood , Blood Gas Analysis , Child , Child, Preschool , Double-Blind Method , Emergency Medicine/methods , Female , Hospitalization , Humans , Male , Peak Expiratory Flow Rate/drug effects , Pediatrics/methods , Prospective Studies , Respiration/drug effects , Treatment Outcome
7.
J Emerg Med ; 24(3): 271-5, 2003 Apr.
Article in English | MEDLINE | ID: mdl-12676296

ABSTRACT

We report the case of a 9-year-old boy who presented to our community-based Pediatric Emergency Department with complaints of neck pain, stiffness and upper extremity weakness. The symptoms were later identified to be due to cervical extraosseous paraspinal Ewing's sarcoma. The patient had a fatally aggressive clinical course. Cervical extraosseous Ewing's sarcoma is rarely reported in pediatrics. Ewing's sarcoma should be considered in the differential diagnosis of children presenting with complaints of unremitting or recurring non-specific back or neck pain or neurological deficits. Appropriate diagnostic evaluation and treatment should be actively pursued.


Subject(s)
Neuroectodermal Tumors, Primitive, Peripheral/diagnosis , Soft Tissue Neoplasms/diagnosis , Antineoplastic Combined Chemotherapy Protocols , Cervical Vertebrae , Child , Emergency Service, Hospital , Fatal Outcome , Humans , Laminectomy , Magnetic Resonance Imaging , Male , Neck Pain/etiology , Neuroectodermal Tumors, Primitive, Peripheral/complications , Neuroectodermal Tumors, Primitive, Peripheral/surgery , Soft Tissue Neoplasms/complications , Soft Tissue Neoplasms/drug therapy , Soft Tissue Neoplasms/surgery , Spinal Cord Compression/etiology
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