Is a pediatrician performed gray scale ultrasonography with power Doppler study safe and effective for triaging acute non-perforated appendicitis for conservative management?
OBJECTIVE
The purpose of this study was to examine whether acute non-perforated appendicitis (ANPA) can be safely triaged by a pediatrician for conservative management (CM) using gray-scale ultrasonography with power Doppler (GSPD).


METHODS
Seventy five cases of ANPA assessed by a pediatrician with GSPD (2013-2015) were reviewed. GSPD grading for ANPA was: I: slightly irregular wall/normal blood flow; II: irregular wall/increased blood flow; III: irregular wall/decreased blood flow; and IV: absence of wall/blood flow. Grades I/II were managed conservatively with intravenous antibiotics then encouraged to book for interval appendectomy (IA). Grades III/IV were reviewed for emergency appendectomy (EA) by a pediatric surgeon.


RESULTS
GSPD grading was I (n=26), II (n=36), III (n=9), and IV (n=4). EA was required for 5 cases, one grade III, and four grade IV cases. One grade IV case was treated conservatively after surgical review but EA was unavoidable. Of the remaining 70 cases discharged well after a mean of 5.7days hospitalization, 25/70 had IA with chronic inflammation on histology, 6/70 had recurrence of ANPA treated successfully by EA, and 39/70 remain asymptomatic at least 10months after declining IA. Overall, GSPD triaging with CM was cheaper than surgery.


CONCLUSIONS
GSPD performed by pediatricians appears to be safe/effective for triaging ANPA.


METHODS
Level III.
Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
Keisuke
K
Jimbo
Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Pediatric Surgery, Tobu Chiiki Hospital, Tokyo, Japan. Electronic address: mstakeda@juntendo.ac.jp.
Masahiro
M
Takeda
Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan; Department of Pediatrics, Tobu Chiiki Hospital, Tokyo, Japan.
Eri
E
Miyata
Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Hiroshi
H
Murakami
Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
Reiko
R
Kyodo
Department of Pathological Diagnosis, Tobu Chiiki Hospital, Tokyo, Japan.
Hideki
H
Orikasa
Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Geoffrey J
GJ
Lane
Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
Toshiaki
T
Shimizu
Department of Pediatric General & Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan; Department of Pediatric Surgery, Tobu Chiiki Hospital, Tokyo, Japan.
Atsuyuki
A
Yamataka
D000208:Acute Disease; D000293:Adolescent; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D000072700:Conservative Treatment; D005260:Female; D006801:Humans; D008297:Male; D000072143:Pediatricians; D012189:Retrospective Studies; D014218:Triage / Q000379:methods*; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods*
Acute non-perforated appendicitis; Conservative management; Emergency appendectomy; Interval appendectomy; Power Doppler study