原作者： Jennifer Guyther，步涨 文章来源： 《中华急诊医学杂志》编辑部 发布日期：2014-08-12
Title: Indeterminate ultrasound results in kids
题目：儿童超声检查结果中的不确定性
Author 作者: Jennifer Guyther
翻译：步涨 校对：陈都，肖锋
Ultrasound is gaining favor as a radiation free tool for evaluating appendicitis. However, we are all faced with a challenge when the ultrasound is unable to visualize the appendix. What is the next step? Do we CT these kids? Observe them? MRI them? Admit to surgery? Certainly some of these decisions are made by the institution where you practice, but one study looked at the clinical outcomes in kids where the "appendix was not fully visualized."
超声检查在评估阑尾炎中获得临床工作者的青睐，因其有无辐射的优点。但是，我们都在面临着挑战：当超声无法显示出阑尾怎么办，接下来该怎么办？需要给这些孩子做CT么？或是仅仅进行留观？给他们做磁共振？还是让他们去开刀？当然有时候你所在的医疗机构为你做出决定，但一项研究显示了当超声出现“没有看到整个阑尾”时这些儿童的临床结果。
-Retrospective chart review in a tertiary Canadian hospital of kids 2-17 who had US for suspected appendicitis (968 pts)
回顾性分析了一家加拿大综合医院中2-17岁因怀疑阑尾炎而做超声检查患者（968例）
-526 kids had incompletely visualized appendices:
526名儿童的阑尾显示不全
55 went to the OR
55名做了手术
160 were observed
160名留观
-105 were discharged home with no return visits
105名出院回家后没有回医院随诊
- 55 had appendectomies
55名行阑尾切除术
-39 had appendicitis confirmed by pathology
39例病理证实阑尾炎
311 went home
311例回家
-58 bounced-back
58例又返回了医院
-1 had appendicitis confirmed by pathology
1例病理证实阑尾炎
-442 kids had fully visualized appendices
442个孩子的阑尾显影完整
232 were consistent with appendicitis
232例表现为阑尾炎
Bottom line: 15% of kids with an incompletely visualized appendix have appendicitis, so serial reexamination is imperative. If repeat clinical exams are reassuring, then the miss rate (for this study) was <0.3%.
要点：15%阑尾显影不清的孩子最终确诊为阑尾炎，所以系列复查非常必要；如果再次的检查还是正常，则漏诊率（本研究中）是小于0.3%的。
References 参考文献 ：
Ross MJ, Liu H, Netherton SJ, Eccles R, Chen PW, Boag G, Morrison E, and GC Thompson. Outcomes of Children With Suspected Appendicitis and Incompletely Visualized Appendix on Ultrasound. Acad Emerg Med. 2014 May;21(5):538-542.
