Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Added Value of Structured Reporting for US of the Pediatric Appendix: Additional CT Examinations and Negative Appendectomy

소아 충수 초음파 검사에서 구조화 판독문의 부가가치: 추가 CT 검사 및 음성 충수절제술의 관점에서

  • Keonwoo Choi (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Ji Young Choi (Department of Radiology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital) ;
  • Hyuk Jung Kim (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Hyun Jin Kim (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Suk Ki Jang (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital)
  • 최건우 (대진의료재단 분당제생병원 영상의학과) ;
  • 최지영 (성균관대학교 의과대학 강북삼성병원 영상의학과) ;
  • 김혁중 (대진의료재단 분당제생병원 영상의학과) ;
  • 김현진 (대진의료재단 분당제생병원 영상의학과) ;
  • 장석기 (대진의료재단 분당제생병원 영상의학과)
  • Received : 2022.03.13
  • Accepted : 2022.09.02
  • Published : 2023.05.01
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Abstract

Purpose This study aimed to determine the incremental value of using a structured report (SR) for US examinations of the pediatric appendix. Materials and Methods Between January 2009 and June 2016, 1150 pediatric patients with suspected appendicitis who underwent US examinations of the appendix were included retrospectively. In November 2012, we developed a five-point scale SR for appendix US examinations. The patients were divided into two groups according to the form of the US report: free-text or SR. The primary clinical outcomes were compared between the two groups, including the rate of CT imaging following US examinations, the negative appendectomy rate (NAR), and the appendiceal perforation rate (PR). Results In total, 550 patients were included in the free-text group and 600 patients in the SR group. The rate of additional CT examinations decreased by 5.3% in the SR group (8.2%, p = 0.003), and the NAR decreased by 8.4% in the SR group (7.8%, p = 0.028). There was no statistical difference in the appendiceal PR (37.6% vs. 48.0%, p = 0.078). Conclusion The use of an SR to evaluate US examinations for suspected pediatric appendicitis results in lower CT use and fewer negative appendectomies without an increase in appendiceal PR.

목적 본 연구에서는 소아 충수 초음파에서 구조화 판독문을 이용하는 것의 증분가치를 보고자 하였다. 대상과 방법 이 후향적 연구에는 2009년 1월부터 2016년 6월 사이에 충수염이 의심되는 소아환자 1150명이 포함됐다. 2012년 11월, 충수 초음파에 대한 5점 척도의 구조화 판독문을 도입했다. 환자들은 초음파 판독문 양식에 따라 자유 텍스트 그룹과 구조화 판독문 그룹으로 나뉘었다. 초음파 검사 후 추가적 CT 검사율, 음성 충수절제율 및 충수 천공률을 포함한 주요임상 결과를 두 그룹 간에 비교했다. 결과 자유 텍스트 그룹에서 550명의 환자와 구조화 판독문 그룹에서 600명의 환자가 선별되었다. 추가 CT 검사 비율은 구조화 판독문 그룹에서 8.2%로 5.3%가 감소했다(p = 0.003). 음성 충수절제율은 구조화 판독문 그룹에서 7.8%로 8.4% 감소했다(p = 0.028). 충수 천공률(37.6% vs. 48.0%, p = 0.078)은 통계적으로 차이가 없었다. 결론 충수염이 의심되는 소아 환자에서 초음파 검사 시 구조화 판독문을 사용하면 추가 CT 검사율이 감소하고, 충수 천공률의 증가 없이 음성 충수절제율이 감소한다.

Keywords

References

  1. Scholer SJ, Pituch K, Orr DP, Dittus RS. Clinical outcomes of children with acute abdominal pain. Pediatrics 1996;98(4 Pt 1):680-685
  2. Puylaert JB, van der Zant FM, Rijke AM. Sonography and the acute abdomen: practical considerations. AJR Am J Roentgenol 1997;168:179-186
  3. Fallon SC, Orth RC, Guillerman RP, Munden MM, Zhang W, Elder SC, et al. Development and validation of an ultrasound scoring system for children with suspected acute appendicitis. Pediatr Radiol 2015;45:1945-1952
  4. Larson DB, Towbin AJ, Pryor RM, Donnelly LF. Improving consistency in radiology reporting through the use of department-wide standardized structured reporting. Radiology 2013;267:240-250
  5. Schwartz LH, Panicek DM, Berk AR, Li Y, Hricak H. Improving communication of diagnostic radiology findings through structured reporting. Radiology 2011;260:174-181
  6. Larson DB, Trout AT, Fierke SR, Towbin AJ. Improvement in diagnostic accuracy of ultrasound of the pediatric appendix through the use of equivocal interpretive categories. AJR Am J Roentgenol 2015;204:849-856
  7. Partain KN, Patel AU, Travers C, Short HL, Braithwaite K, Loewen J, et al. Improving ultrasound for appendicitis through standardized reporting of secondary signs. J Pediatr Surg 2017;52:1273-1279
  8. Nielsen JW, Boomer L, Kurtovic K, Lee E, Kupzyk K, Mallory R, et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg 2015;50:144-148
  9. Jeffrey RB Jr, Laing FC, Townsend RR. Acute appendicitis: sonographic criteria based on 250 cases. Radiology 1988;167:327-329
  10. Worrell JA, Drolshagen LF, Kelly TC, Hunton DW, Durmon GR, Fleischer AC. Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria. J Ultrasound Med 1990;9:145-150
  11. Trout AT, Sanchez R, Ladino-Torres MF. Reevaluating the sonographic criteria for acute appendicitis in children: a review of the literature and a retrospective analysis of 246 cases. Acad Radiol 2012;19:1382-1394
  12. Reiner BI, Knight N, Siegel EL. Radiology reporting, past, present, and future: the radiologist's perspective. J Am Coll Radiol 2007;4:313-319
  13. Park SB, Kim MJ, Ko Y, Sim JY, Kim HJ, Lee KH; LOCAT Group. Structured reporting versus free-text reporting for appendiceal computed tomography in adolescents and young adults: preference survey of 594 referring physicians, surgeons, and radiologists from 20 hospitals. Korean J Radiol 2019;20:246-255
  14. Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, et al. Low-dose abdominal CT for evaluating suspected appendicitis. N Engl J Med 2012;366:1596-1605