2015 HSC Section 1 Book of Articles
Collins
et
al.
/ International
Journal
of Pediatric Otorhinolaryngology 78
(2014)
423–426
B.
Table 2 Sensitivity,
specificity,
positive
and
negative
predictive
values
of
ultrasound
and
computed
tomography
as
compared
to
the
gold
standard,
drainage
of
abscess.
Method
Sensitivity
Specificity
Positive predictive value a
Negative
predictive
value a
negative/total c
Counts positive/total b
Estimate 95%
CI
Counts
Estimate 95%
CI
Estimate 95%
CI
Estimate 95%
CI
Ultrasound 18/34
0.53 0.68
0.35–0.70 5/5 0.57–0.77 2/11
1.0
0.48–1.00 0.96 0.02–0.52 0.88
0.86–0.99 0.16 0.85–0.91 0.06
0.10–0.23 0.02–0.19
CT
scan
61/90
0.18
CI
–
confidence
interval;
CT
–
computed
tomography.
Legend:
a Assuming b Sensitivity c Specificity
abscess
prevalence
of
0.90.
data data
presented presented
as
the
number number
of
positive negative
tests tests
out out
of
the the
total total
number with number with
a
gold gold
standard standard
positive negative
status.
as
the
of
of
a
status.
Table 3 Sensitivity
location. a
and
specificity
of
ultrasound
and
computed
tomography
by
abscess
Abscess
location
(total)
Method
Sensitivity
Specificity
positive/total b
negative/total c
Estimate
95%
CI
Counts
Estimate
95%
CI
Counts
cervical
(32)
Ultrasound 8/14
0.57 0.56 0.33 0.69 0.58 0.75 0.66 0.78 Not 0.75
0.29–0.82 0/0 0.30–0.80 0/2
Not
estimable
Anterior
scan
9/16
0
0–0.84
CT
Posterior
cervical
(21)
Ultrasound 1/3
0.008–0.91 1/1 0.41–0.89 0/1
1.0
0.025–1.0
scan
11/16
0
0–0.98
CT
Submandibular
and
submental
(30) Ultrasound 7/12
0.28–0.85 1/1 0.48–0.93 0/1
1.0
0.025–1.0
scan
12/16
0
0–0.98
CT
Parapharyngeal
(37)
Ultrasound 2/3
0.094–0.99 1/1 0.58–0.91 2/6
1.0
0.025–1.0
CT
scan
21/27
0.33
0.04–0.78
Parotid
(8)
Ultrasound 0/0
estimable
0/0
Not Not
estimable estimable
scan
6/8
0.35–0.97 0/0
CT
CI
–
confidence
interval;
CT
–
computed
tomography. from multiple
Legend:
a Twelve
imaging
studies
included
abscesses
lateral
neck
locations
and
have
been gold gold
excluded standard standard
from
this
subgroup
analysis.
b Sensitivity c Specificity
data data
presented presented
as
the
number number
of
positive negative
tests tests
out out
of
the the
total total
number with number with
a
positive negative
status.
as
the
of
of
a
status.
abscesses
spanning
multiple
locations.
Confidence
intervals
in
the United States who
receive a head or abdominal CT,
children
the
point small
estimates
are wide,
particularly
for
specificity,
is estimated
that 500 will die of cancer which
is directly
related
around
it
to
the
sample
sizes
of
individual
locations.
No
formal
the CT
[9,10] .
The
cumulative
radiation
exposure
from
two risk
to of
due
to
of
test
performance
were
made
between
CT
and
head
CT
scans
in
children
under
15 may
triple
the
comparisons ultrasound by
three brain
location general, the site-specific estimates are consistent with the overall estimates in which sensitivity is similar but somewhat lower for the ultrasound method compared to CT. given the small subgroup sizes. In
cancer
[11] .
Ultrasound
avoids
the
risks
of
radiation.
One
to
ultrasound
is
that
a
probe must
be
placed
on
the
drawback
this
could
cause
pain
or
discomfort
at
the
infection
child’s neck;
In
the
cases
examined
for
this
study,
the
performance
of
at
site. least
one
ultrasound
and
one
CT
was
limited
by
patient
4. Discussion
When
examining
the
risks
and
benefits
of
both
movement. techniques,
it
is
likely
that ultrasound may be preferred over CT in
study
shows
that ultrasound may be as
sensitive, yet more abscesses when
instances
for
the
diagnosis
of
pediatric
lateral
neck
many
This
than
CT
in
the
diagnosis
of
lateral
neck
specific,
abscesses. We
to
the
gold
standard,
drainage
of
the
abscess.
As
such,
demonstrate
in
this
review
that
ultrasound
may
have
compared
guidelines may be developed based upon the
cost,
safety,
specificity when
compared
to CT
in
the diagnosis of
lateral
practice
greater
discomfort
of
the
two
procedures. administer,
In
2010
in Oklahoma
City,
in
children. This
is of great
importance clinically as
and
neck abscesses
cost
$79.97
to
while
CT
administration to sedate a child
goal
for
imaging
is
often
to
determine who
does
not
need
to
ultrasound
our
[7] .
It
is often necessary
surgical drainage.
In our population of children who were
with contrast cost $220.11
undergo already
undergo
a
CT
scan,
adding
to
its
cost
and
associated
risk.
treated
with
24 h
of
intravenous ultimately
clindamycin,
the
to
rare,
is a potential
side effect
of
abscesses
in
those
requiring
incision reliably
Contrast associated allergy, although
prevalence
[8] . For children,
there may be an
increased
fear of CT because
of CT they
and drainage was 89%. Considering such a high prevalence,
have
to
be
separated
from
their
parent
or
guardian avoided
for
an
those children who do not have an abscess and are unlikely
finding
period
of
time.
Separation
anxiety
is
when
from
surgical drainage
is critical. Although our numbers
extended ultrasound
to benefit
is used. There are many concerns about
specificity were
small
for
both
ultrasound
and
CT,
ultrasound
for
the negative
long-term effects
superior.
was
radiation
from CT. Computed
tomography-related statistically-significant
x-ray doses epidemio-
diagnostic
protocol
that
promotes
judicious
and
individual- abscesses
of
A
large
enough
that
there
is
use
of
ultrasound
and
CT
in
the
diagnosis
of
neck
are
ized
small
increase
in
lifetime attributable in 80 year old men
risk of
likely prove
to be beneficial
for
these
children. To decrease
logical evidence of a
would
incidence,
ranging
from 0.02%
to nearly risks are 600,000
discomfort,
and
potential
harm
to
the
child,
an
ultrasound
cancer
cost, may
1% in 20 year old women undergoing CT
[8] . On average,
be
preferred
as
the
first
line
imaging
technique
in
many some
Computed
tomography
may
be
useful
in
situations.
larger
for
children
than
adults.
Annually,
out
of
0.07%
218
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