Physicians can safely reduce the use of computed tomography (CT) scans in children who have a suspected appendicitis by performing an ultrasound first, according to preliminary results of a retrospective study presented at Touro College Research Day.
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"CT scans are routinely used to diagnosis acute appendicitis, but also involve radiation exposure, which is a concern when treating children," says Suhal Shah, a third-year resident at Touro College of Osteopathic Medicine. Shah collaborated with project leader Victor Todisco, MD, a pediatric radiologist at Orange Regional Medical Center. The American College of Radiology and the American College of Surgeons recommend using ultrasound first to reduce radiation exposure, but the appendix is difficult to find using this method. This study compared testing trends and outcomes of pediatric patients who came to the Orange Regional Medical Center with suspected appendicitis during two periods of time, 2011-2012 and 2014-2015.
Researchers found that rates of using CT scans first dropped from 12.8 to 7.5 percent between the two time periods. "These results show that our hospital is doing better at following the recommendations by using ultrasound first, and then if indicated, moving on to CT," says Shah. "That shows that we are limiting radiation exposure in children."
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The study also found that when the appendix is found on an ultrasound, the results - both positive and negative - are accurate, and no further testing is necessary. However, ultrasounds only found the appendix in about 10 percent of cases. But even in those who had an inconclusive result, only those with a high clinical suspicion of appendicitis went on to have a CT. Of the children that did not have a CT, none returned to the hospital with a missed appendicitis.
"It's worth doing ultrasound because sometimes we can pick up a positive or negative appendicitis," says Shah. "If it's inconclusive, it's only worth moving on to doing a CT if you have high clinical suspicion, so overall, we are reducing radiation exposure."
The review author team, from the All India Institute of Medical Sciences, New Delhi and LSTM, examined all data published up to 18 March 2016. They included nine trials, with 1337 people in total, which evaluated the effect of giving dexamethasone, methylprednisolone, or prednisolone along with anti-tuberculosis drugs. One included trial was of high quality while all other included trials had inconsistencies due to incomplete reporting.
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The review authors found that corticosteroids reduce the risk of death by a quarter at two months to two years after the start of treatment. One trial followed up all of the participants for five years, by which time there was no difference in the effect on death between the groups given the corticosteroids and those that weren't; however the reasons for this change over time is unknown. This trial also looked at the effects of corticosteroids on HIV-positive people, but the small number of included participants meant that the review authors were unsure if the benefits in terms of a reduction of death was preserved in this group of participants.
Dr. Hannah Ryan from LSTM, who led the review update, said: "The highest quality evidence clearly shows steroids reduce deaths by a quarter. Estimates for severe disability are not so accurate as it is far less common, but even the most pessimistic statistical estimate from the trials tells us that the benefits of steroids from lower mortality benefit far more patients than the possible small possible increase in disability in the survivors."
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The CIDG has been in operation since 1994. With over 600 authors from 52 countries it is led by Professor Paul Garner, Dr David Sinclair, and Anne-Marie Stephani, with its editorial base at LSTM.
ban cay an xoa tai hcm
"CT scans are routinely used to diagnosis acute appendicitis, but also involve radiation exposure, which is a concern when treating children," says Suhal Shah, a third-year resident at Touro College of Osteopathic Medicine. Shah collaborated with project leader Victor Todisco, MD, a pediatric radiologist at Orange Regional Medical Center. The American College of Radiology and the American College of Surgeons recommend using ultrasound first to reduce radiation exposure, but the appendix is difficult to find using this method. This study compared testing trends and outcomes of pediatric patients who came to the Orange Regional Medical Center with suspected appendicitis during two periods of time, 2011-2012 and 2014-2015.
Researchers found that rates of using CT scans first dropped from 12.8 to 7.5 percent between the two time periods. "These results show that our hospital is doing better at following the recommendations by using ultrasound first, and then if indicated, moving on to CT," says Shah. "That shows that we are limiting radiation exposure in children."
cay an xoa o binh phuoc
The study also found that when the appendix is found on an ultrasound, the results - both positive and negative - are accurate, and no further testing is necessary. However, ultrasounds only found the appendix in about 10 percent of cases. But even in those who had an inconclusive result, only those with a high clinical suspicion of appendicitis went on to have a CT. Of the children that did not have a CT, none returned to the hospital with a missed appendicitis.
"It's worth doing ultrasound because sometimes we can pick up a positive or negative appendicitis," says Shah. "If it's inconclusive, it's only worth moving on to doing a CT if you have high clinical suspicion, so overall, we are reducing radiation exposure."
The review author team, from the All India Institute of Medical Sciences, New Delhi and LSTM, examined all data published up to 18 March 2016. They included nine trials, with 1337 people in total, which evaluated the effect of giving dexamethasone, methylprednisolone, or prednisolone along with anti-tuberculosis drugs. One included trial was of high quality while all other included trials had inconsistencies due to incomplete reporting.
tac dung cay an xoa
The review authors found that corticosteroids reduce the risk of death by a quarter at two months to two years after the start of treatment. One trial followed up all of the participants for five years, by which time there was no difference in the effect on death between the groups given the corticosteroids and those that weren't; however the reasons for this change over time is unknown. This trial also looked at the effects of corticosteroids on HIV-positive people, but the small number of included participants meant that the review authors were unsure if the benefits in terms of a reduction of death was preserved in this group of participants.
Dr. Hannah Ryan from LSTM, who led the review update, said: "The highest quality evidence clearly shows steroids reduce deaths by a quarter. Estimates for severe disability are not so accurate as it is far less common, but even the most pessimistic statistical estimate from the trials tells us that the benefits of steroids from lower mortality benefit far more patients than the possible small possible increase in disability in the survivors."
cay an xoa mua o dau
The CIDG has been in operation since 1994. With over 600 authors from 52 countries it is led by Professor Paul Garner, Dr David Sinclair, and Anne-Marie Stephani, with its editorial base at LSTM.