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J Korean Soc Emerg Med > Volume 26(5); 2015 > Article
Journal of The Korean Society of Emergency Medicine 2015;26(5): 474-479.
소아 응급실에서 급성 충수염의 영상검사 변화 추이와 음성개복술 비율의 변화
정지혜1, 곽영호1, 이진희1, 김도균1, 장익완1, 정진희2, 정재윤3, 권혁술3
1서울대학교병원 응급의학과
2서울시립보라매병원 응급의학과
3분당서울대학교병원 응급의학과
Changes in the Trend of the Imaging Study in Children with Acute Appendicitis in the Pediatric Emergency Department and Changes of the Negative Appendectomy Rate (NAR)
Ji Hae Jung1, Young Ho Kwak1, Jin Hee Lee1, Do Kyun Kim1, Ikwan Chang1, Jin Hee Jeong2, Jae Yun Jung3, Hyulsool Kwon3
1Department of Emergency Medicine, College of Medicine Seoul National University, Korea
2Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
3Seoul National University Bundang Hospital, Gyeonggido, Korea
Correspondence  Young Ho Kwak ,Tel: 02) 2072-1629, Fax: 02) 3672-8871, Email: yhkwak@snuh.org,
Received: July 16, 2015; Revised: July 20, 2015   Accepted: September 7, 2015.  Published online: October 30, 2015.
ABSTRACT
Purpose:
We evaluated the relationship between changes in the trend of the utilization of diagnostic imaging studies and the rates of negative appendectomy, complications in pediatric patients with appendicitis.
Method:
This retrospective observational study was conducted at a pediatric emergency department (PED) of a tertiary university hospital. Patients who underwent imaging studies under the clinical impression of acute appendicitis and underwent appendectomy at the hospital from 2010 to 2013 were enrolled. We compared the percentages of imaging studies performed and negative appendectomy rate (NAR), complications between first two years (FTY) and second two years (STY).
Results:
The total number of patients was 197 with a mean age of 9.68 (±3.17) years, and 66% were boys. The percentages of performed computed tomography (CT) of FTY and STY were 46.2% and 25.5% (p<0.05). Patients who were evaluated by ultrasound alone were 53.8% and 74.5%, respectively (p<0.05). The NARs of the two groups were 13.2% (FTY) and 8.0% (STY) (p=0.19). There was no significant difference in the number of hospital days, drainage insertion rates, duration of draining, and the rates of perforations between groups. The duration of antibiotics use was significantly longer only in the STY group than in the FTY group (6.20±3.95 vs. 6.94±3.41 days, p=0.04).
Conclusion:
Although the number of patients who underwent ultrasound without a CT scan for the diagnosis of acute appendicitis was increased, the NAR and clinically important complications were comparable from the preceding two years at a tertiary PED.
Key words: Appendicitis, Appendectomy, Diagnostic imaging, Emergency medical service
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