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Advance Directive Status in >65yo ED Population

Posted by on Feb 6, 2018 in Articles, ePubs | 0 comments

Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population

Author: Kelsey Grace , Michelle Carson MD, August Grace, David Betten MD

Author Affiliations: Sparrow Hospital Department of Emergency Medicine

Full Text Article PDF

Corresponding Author: Kelsey Grace, gracekel@msu.edu

 

Abstract:

Advance directives are an important aspect of medical care for the elderly given the uncertainty of health and longevity. In their absence, family and physicians are often left with questions regarding what patient’s wishes would entail if they become incapacitated. Individuals >65 years presenting to the ED were surveyed during the months of June-September 2015 by study investigators regarding their knowledge and utilization of advance directives. 168 patient surveys were completed with a mean age of 77.2 (SD ±7.45 years; range 65-97). Of those, 91% were either ―very familiar‖ or ―somewhat familiar‖ with Advance Directives with 76.1% having some form of documented advance directives in place. Of those who felt family were aware of their wishes, 84.9% had assigned a Medical Durable Power of Attorney. Only a small minority had developed advance directives with their physician’s assistance (6.8%). The majority of patients stated that they had prepared their end of life documents with a Lawyer (72%). Only 35.8% of patients sampled had even mentioned the topic or their specific wishes with their primary care or ED physician. Overall rates of formalized advance directives would appear to be highly utilized in this patient population with little variation based upon respondents’ self-assessment of physical health. A surprising finding was how minor of a role physicians appear to play in the development of ADs. This provides an opportunity to enhance the physician-patient relationship and improve patient education regarding end of care discussions. Physicians should take initiative and begin having these conversations, in order to ensure that patients are making educated decisions and that proper documentation is occurring.

Published on date: February, 2018

DOI: 10.15404/msrj/02.2018.0152

Citation: Grace, K., Carson, M., Grace, A. et al. Advance Directive Status in the Greater Than 65-Year-Old Emergency Department Population, Medical Student Research Journal (2018). doi:10.15404/msrj/02.2018.0152

References:

1. Koch, K. Patient Self-Determination Act. J Fla Med Assoc. 1992. 79:240–243.

2. O’Sullivan, R., Malio, K., Angeles, R., Agarwal, G. Advance directives: survey of primary care patients. Can Fam Physicians. 2015. 61(4):353-356.

3. Oulton, J., Rhodes, S., Howe, C., et al. Advanced directives for older adults in the emergency department: a systematic review. J Pallait Med. 2015. 18(6):500-505.

4. Llovera, I., Ward, M., Ryan, J., et al. Why don’t emergency department patients have Advanced directives? Academic Emergency Medicine. 1999. 6(10):1054-1060.

5. Ishihara KK, Wrenn K, Wright SW, Socha CM, Cross M. Advance directives in the emergency department: too few, too late. Acad Emerg Med. 1996. 3:50–53.

6. Emanuel LL, Barry MJ, Stoeckle JD, Ettelson LM, Emanuel EJ. Advance directives for medical care—a case for greater use. New Engl J Med. 1991;324(13):889–895.

7. Spoelhof GD, Elliott B. Implementing Advance directives in office practice. Am Fam Physician. 2012. 85(5):461–466.

8. Edinger W, Smucker DR. Outpatients’ attitudes regarding Advance directives. J Fam Pract. 1992. 35(6):650–653.

9. Tierney WM, Dexter PR, Gramelspacher GP, Perkins AJ, Zhou XH, Wolinsky FD. The effect of discussions about Advance directives on patients’ satisfaction with primary care. J Gen Intern Med. 2001;16(1):32–40. (Patient satisfaction with physicians increases if directives are discussed).

Vol 5: Fall 2017 Issue

Posted by on Feb 3, 2018 in Featured, Issues | 0 comments

Vol 5: Fall 2017 Issue

MSRJ – Volume 5 – Fall 2017

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Equator Manuscript Reporting Guidelines

Posted by on Feb 3, 2018 in Featured, In The News | 0 comments

Equator Manuscript Reporting Guidelines

Hello authors,

We at MSRJ are working hard to streamline the manuscript review process to reduce the time between submission date and when a decision is made on final publication.   One of the numerous barriers to fast and efficient manuscript review is something that is under author control – the quality of the submitted manuscript.   In this post, I will describe an indispensable tool all authors should use in preparing a manuscript for publication.

The resource I am referring to is the “Reporting Guideline”.  A reporting guideline is a document that outlines the minimum required content for your manuscript.  It is like a checklist of what information should be included in your manuscript. The purpose of a guideline is to ensure authors provide required information such that a reader knows exactly what you did in your study, and if so desired, they could repeat your study using only your manuscript as a guide. The goal is to ensure all published research papers have proper reporting of details to ensure they can be critically appraised, utilized in systematic reviews, or repeated.

Use of a reporting guideline when writing your manuscript will also help shorten the time it takes from manuscript submission to journal decision.  One of the major delays in the review process occurs when submitted manuscripts have missing information.   This requires the journal to request a resubmission of the manuscript with the missing information, often requiring a second review.  To avoid such a needless delay, we strongly recommend using a reporting guideline when submitting a manuscript to MSRJ.

equator_logo

So what should MSRJ authors do?

(1) Go to The Equator Network website (http://www.equator-network.org/). The Equator Network hosts hundreds of reporting guidelines on many different study design types.  There are reporting guidelines for randomized trials, observational studies, systematic reviews, qualitative research, and case reports, among many others.

(2) On the Equator Network website, find the guideline appropriate to your study type.

(3) Once you have found the appropriate guideline, use the associated checklists to ensure you report all required information.

(4) Finally, cite the guideline you used in your manuscript.

By utilizing the appropriate guideline and adhering to its recommendations, you will ensure a smooth initial review and help improve the quality of research reporting in general.

Sincerely,

Mark Trottier, Ph.D.

MSRJ Faculty Advisor

Reviewer of the Month

Posted by on Jan 11, 2018 in Featured, Staff | 0 comments

Reviewer of the Month

We are starting something new at MSRJ this year- we plan on recognizing a staff member each month that we feel has gone above and beyond! We will post a little bit about this staff member and put up a picture.

This month we would like to thank and recognize Aidan Tan. Thank you for being a part of MSRJ, Aidan!

Here is a little bit about him:

Where are you from? Sydney, Australia.

What is your favorite book? ‘Untamed and Unashamed: The Autobiography’ by Pauline Hanson.

What is your favorite movie? ‘Pauline Hanson: Please Explain!’ by Anna Broinowski.

What kind of article is your favorite to review and why? Original research, because to every medical question, original research replies “Please explain?”

What specialty do you want to go into and why? Emergency medicine, because I will never understand how anyone can work in One Nation; I much prefer the world.

What do you like to do in your free time? Write satire.

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Thanks again, Aidan!

Case Report of Glanzmann Thrombasthenia

Posted by on Sep 18, 2017 in Articles, ePubs | 0 comments

Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia

Author: Ahmed Al Wahab1 , Alaa Nugud, M.D.2 , Shomous Nugud M.D.3, Zahran Alras1

Author Affiliations:

1College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
2Department of Pediatrics, Dubai Health Authority, Dubai, United Arab Emirates
3Department of Research, Sharjah Institute for Medical Research, Sharjah, United Arab Emirates

Full Text Article PDF

Corresponding Author: Ahmed Al Wahab, a7md13@gmail.com

Key Words: Glanzmann Thrombasthenia, inherited platelet disorder, the disorder of hemostasis

Abstract:

Background

Glanzmann Thrombasthenia (GT) is a rare inherited genetic platelet disorder characterized by a qualitative, or quantitative mutation in GPIIb/IIIa receptor; which results in defective platelet aggregation and diminished clot retraction.

Case

A 19-year-old Arab descent female presented to emergency department with severe menorrhagia. On examination an ill looking pale patient in addition to generalized fatigue of one-week duration.

Conclusion

Acquired platelet disorders are more frequently encountered in practice than inherited ones, usually due to medical therapy or an underlying medical condition. GT, was previously known as hereditary hemorrhagic thrombasthenia, is an autosomal recessive disorder that is often disregarded as it has many clinical and laboratory findings similar to some acquired platelet disorders.

Published on date: September, 2017

DOI: 10.15404/msrj/09.2017.0127

Citation: Al Wahab, A., Nugud, A., Nugud, S., & Alras, Z. Unexplained Bleeding: Case Report of Glanzmann Thrombasthenia, Medical Student Research Journal (2017). doi:10.15404/msrj/09.2017.0127

References:

  1. Stevens, R. & Meyer, S. (2002). Fanconi and Glanzmann: the men and their works. British Journal Of Haematology, 119(4), 901-904. http://dx.doi.org/10.1046/j.1365-2141.2002.03812.x
  2. Nurden, A., Ruan, J., Pasquet, J., Gauthier, B., Combrié, R., Kunicki, T., & Nurden, P. (2002). A novel 196 Leu to Pro substitution in the β3 subunit of the αIIbβ3 integrin in a patient with a variant form of Glanzmann thrombasthenia. Platelets, 13(2), 101-111. http://dx.doi.org/10.1080/09537100220122466
  3. Solh, M., Solh, T., & Botsford, A. (2015). Glanzmann's thrombasthenia: pathogenesis, diagnosis, and current and emerging treatment options. Journal Of Blood Medicine, 219. http://dx.doi.org/10.2147/jbm.s71319
  4. Di Minno, G., Zotz, R., d’Oiron, R., Bindslev, N., Di Minno, M., & Poon, M. (2015). The international prospective Glanzmann Thrombasthenia Registry: treatment modalities and outcomes in non-surgical bleeding episodes in Glanzmann thrombasthenia patients. Haematologica. http://dx.doi.org/10.3324/haematol.2014.121475
  5. iore, M., Nurden, A., Nurden, P., & Seligsohn, U. (2012). Clinical utility gene card for: Glanzmann thrombasthenia. European Journal Of Human Genetics, 20(10), 1102-1102. http://dx.doi.org/10.1038/ejhg.2012.178
  6. George, J., Caen, J., & Nurden, A. (1990). Glanzmann’s thrombasthenia: the spectrum of clinical disease. Blood, 75(7), 1383-1395.
  7. Seligsohn, U. (2003). Glanzmann thrombasthenia: a model disease which paved the way to powerful therapeutic agents. Pathophysiology Of Haemostasis And Thrombosis, 32(5-6), 216-217. http://dx.doi.org/10.1159/000073569.

Three Wishes Survey

Posted by on Sep 18, 2017 in Articles, ePubs | 0 comments

Are medical students becoming less altruistic and more money-oriented? A three wishes survey

Author: Anna I. Perera MSc1, Anna Serlachius PhD1, Roger J. Booth PhD2 & Keith J. Petrie PhD1

Author Affiliations:

1Department of Psychological Medicine, University of Auckland, NZ

2Department of Molecular Medicine and Pathology, University of Auckland, NZ

Full Text Article PDF

Corresponding Author: Anna I. Perera, anna.perera@auckland.ac.nz

Key Words: undergraduate, motivations, altruism, money, specialization

Abstract:

Purpose

In this study we assessed the underlying values and goals of current medical students by examining personal wishes. The authors also aimed to determine the impact of the increased financial burden of medical training on students‟ motivations by comparing current wishes to those of students from 1999. We also examined the relationships between types of wishes, choice of future medical specialty, and demographic characteristics.

Methods

An anonymous survey with the question: “If you had three wishes, what would you wish for?”, and items pertaining to specialization choice and demographics was completed by 418 medical students. Wishes were coded into seventeen categories. Results were compared to a previous survey conducted in 1999.

Results

The largest category of wishes was altruism (40% of students) followed by achievement (36%), and money (34%). Significantly more medical students in 2015 had altruistic and achievement wishes compared to 1999. However, there was no significant increase in money-related wishes in the 2015 cohort compared to students from 1999. Final year students were more likely to report power-related wishes and male medical students had significantly more wishes related to power, money, and self-esteem. Students who aspired to be surgeons had more affiliation wishes and fewer knowledge-related aspirations. Conversely, medical students planning to enter internal medicine training were more likely to have wishes related to power and self-esteem. Achievement wishes were more common among individuals wanting to enter family medicine.

Conclusion

There was no evidence that medical students are becoming less altruistic and more money-orientated. Further, individuals did not appear to become less altruistic or increasingly financially driven as they progressed through the medical course.

Published on date: September, 2017

DOI: 10.15404/msrj/09.2017.0145

Citation: Perera, A., Serlachius, A., Booth, R., & Petrie K. Are Medical Students becoming Less Altruistic and More Money-Oriented? A Three Wishes Study, Medical Student Research Journal (2015). doi:10.15404/msrj/09.2017.0145

References:

  1. Vidayarthi AR, Kamei, R, Chan, K, Sok-Hong, G, Ngee, L. Factors associated with medical students clinical reasoning and evidence based medicine practice. Int J Med Educ 2015;6:142-148. http://dx.doi.org/10.5116/ijme.563a.5dd0
  2. Borges NJ, Hartung PJ. Stability of values during medical school. Med Teach 2010;32(9):779-781. http://dx.doi.org/10.3109/01421591003692706
  3. Newton BW, Barber L, Clardy J, Cleveland E, O’Sullivan P. Is there hardening of the heart during medical school? Acad Med 2008;83(3):244-249. http://dx.doi.org/10.1097/ACM.0b013e3181637837.
  4. Hojat M, Vergare MJ, Maxwell K, Brainard G, et al. The devil is in the third year: a longitudinal study of erosion of empathy in medical school. Acad Med 2009;84(9);1182-1191. http://dx.doi.org/10.1097/ACM.0b013e3181b17e55
  5.   Chen DCR, Kirshenbaum DS, Yan J, Kirshenbaum E, Aseltine RH. Characterizing changes in student empathy throughout medical school. Med Teach 2012;34(4):305-311. http://dx.doi.org/10.3109/0142159X.2012.644600
  6. Morley CP, Roseamelia C, Smith J, Villarreal AL. Decline of medical student idealism in the first and second year of medical school: a survey of pre-clinical medical students at one institution. Med Ed 2013;18:21194. http://dx.doi.org/10.3402/meo.v18i0.21194
  7. Mader EM, Roseamelia C, Morley CP. The temporal decline of idealism in two cohorts of medical students at one institution. BMC Med Ed 2014;14:58. http://dx.doi.org/10.1186/1472-6920-14-58.
  8. Stephens MB, Landers MB, Davis G, Durning, SW, Crandall SJ. Medical student attitudes toward the medically underserved: the USU perspective. Mil Med 2015;180(4):61-63. http://dx.doi.org/10.7205/MILMED-D-14-00558.
  9. Neumann M, Edelhäuser F, Tauschel D, Fischer MR, et al. Empathy decline and its reasons: a systematic review of studies with medical students and residents. Acad Med 2011;86(8):996-1009. http://dx.doi.org/10.1097/ACM.0b013e318221e615.
  10. Dwinnell B, Adams L. Why we are on the cusp of a generalist crisis. Acad Med 2001;76(7);707-708.
  11. Morra DJ, Regehr G, Ginsburg S. Anticipated debt and financial stress in medical students. Med Teach 2008;30(3):313-315. http://dx.doi.org/10.1080/01421590801953000.
  12. O‟Grady G, Fitzjohn J. Debt on graduation, expected place of practice, and career aspirations of Auckland Medical School students. NZ Med J 2001;114:468-70.
  13. Faculty of Medical and Health Sciences [Internet]. Auckland: The University of Auckland; c2016 [cited 2016 Aug 18]. Available from: http://www.fmhs.auckland.ac.nz/en/faculty/for/future-undergraduates/undergraduate-study-options/mbchb.html
  14. Collins MG. Medical students and debt: a survey of students at the School of Medicine, University of Auckland. NZ Med J 1999;112(1085):123-6.
  15.  Ministry of Social Development [Internet]. Students studying a Bachelor of Medicine and Bachelor of Surgery receiving student loan payments between 2008 and 2012. Wellington: New Zealand Government; c2013 [cited 2013 Sep 2]
  16. Moore J, Gale J, Dew K, Davie G. Student debt amongst junior doctors in New Zealand; Part 1: Quantity, distribution, and impact. NZ Med J 2006;117(1229):12-20
  17. Greysen SR, Chen C, Mullan F. A history of medical student debt: Observations and implications for the future of medical education. Acad Med 2011; 86:840-845.
  18. Bazemore A, Peterson L, Jetty A, Wingrove P, Petterson S, Phillips R. Over half of graduating family medicine residents report more that $150,000 in educational debt. J Am Board Fam Med 2016; 29:180-181.
  19. Woolf K, Elton M, Newport M. The specialty choices of graduates from Brighton and Sussex Medical School: a longitudinal cohort study. BMC Med Ed 2015;15:46. http://dx.doi.org/10.1186/s12909-015-0328-z.
  20. Lynch DC, Newton DA, Grayson MS, Whitley TW. Influence of medical school on medical students’ opinions about primary care practice. Acad Med 1998;73(4):433-5.
  21. Pawelczyk A, Pawelczyk T, Bielecki J. Differences in medical specialty choice and in personality factors among female and male medical students. Pol Merkuriusz Lek 2007;23(137):363-366.
  22. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol 2003;88(5):879-903.
  23. McAdams DP, Olson BD. Personality development: continuity and change over the life course. Annu Rev Psychol. 2010;61:517-542 http://dx.doi.org/10.1146/annurev.psych.093008.100507.
  24. Petrie KJ, White GR, Cameron LD, Collins JP. Photographic memory, money, and liposuction: survey of medical students’ wish lists. BMJ 1999;319(7225):1593-1595.
  25. King L, Broyles SJ. Wishes, gender, personality and well-being. J Person 1997;65:49-76.
  26. Quince TA, Parker RA, Wood DF, Benson JA. Stability of empathy among undergraduate medical students: A longitudinal study at one UK medical school. BMC Med Ed 2011;11:90 http://dx.doi.org/10.1186/1472-6920-11-90.
  27. Albanese MA, Snow MH, Skochelak HE, Huggett KN, Farrell PM. Assessing personal qualities in medical school admissions. Acad Med 2003;78(3):313-321.
  28. Muller D, Kase N. Challenging traditional premedical requirements as predictors of success in medical school: The Mount Sinai School of Medicine humanities and medicine program. Acad Med 2010;85(8):1378-1383. http://dx.doi.org/10.1097/ACM.0b013e3181dbf22a.
  29. Poole P, Shulruf B, Boyle V. Influence of gender and other factors on medical student specialty interest. NZ Med J 2014;127(1402):78-87
  30. Tweed MJ, Bagg W, Child S, Wilkinson TJ, Weller J. How the trainee intern year can ease the transition from undergraduate education to postgraduate practice. N.Z. Med J 2010;123:81-91.
  31. Prka M, Danic A, Glavas E. What do medical students want from their professional and private life? Croat Med J 2002;43(1):80-83.
  32.  Buss DM. How can evolutionary psychology successfully explain personality and individual differences. Prospect Pscyhol Sci 2009;4(4):359-366. http://dx.doi.org/10.1111/j.1745-6924.2009.01138.x.
  33. Schwartz SH, Rubel T. Sex differences in value priorities: Cross cultural and multimethod studies. J Pers Soc Psychol 2005;89(6):1010-1028.
  34. Moyo M, Goodyear-Smith FA, Weller J, Robb G, Shulruf B. Healthcare practitioners‟ personal and professional values. Adv Hlth Sci Ed 2016;21(2):257-286. http://dx.doi.org/10.1007/s10459-015-9626-9.

Aerococcus Viridans

Posted by on Sep 17, 2017 in Articles, ePubs | 0 comments

Aerococcus Viridans Infectious Endocarditis Complicated by Splenic Infarction

Author: Joshua Budhu M.S, Dorian Wood B.S, Marvin Crawford M.D, Khuram Ashraf M.D, Frederick Doamekpor M.D, Olufunke Akinbobuyi M.D

Author Affiliations: Morehouse School of Medicine, GA, USA

Full Text Article PDF

Corresponding Author: Joshua Budhu, jbudhu@gmail.com

Key Words: splenic infarct, infectious endocarditis, aercoccus viridans, HIV, immunocompromised, hemodialysis

Abstract:

In this case report we discuss splenic infarction as a presentation for infectious endocarditis. While not unheard of, splenic infarctions are usually incidental findings and are not usually used to diagnose infectious endocarditis. Since our patient was on hemodialysis, had AIDS and blood cultures tested positive for Aerococcus viridans and Streptococcus parasanguis, we propose that atypical presentations of IE should be considered in immunocompromised patients.

 

Published on date: September, 2017

DOI: 10.15404/msrj/07.2017.0002

Citation: : Budhu, J., Wood, D., Crawford, M., Ashraf, K., Doamekpor, F., & Akinbobuyi, O. Aerococcus Viridans Infectious Endocarditis Complicated by Splenic Infarction, Medical Student Research Journal (2017). doi:10.15404/msrj/07.2017.0002

References:

  1. Baddour M., Wilson  W.R., Bayer  A.S.; Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 111 2005:e394-e434.
  2. Sanfilippo AJ, Picard MH, Newell JB, Rosas E, Davidoff R, Thomas JD, Weyman AE. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications.J Am Coll Cardiol. 1991; 18:1191–1199. CrossRefMedline.
  3. Fauci, A.S., Braunwald, E., Kasper, D.L., Hauser, S.L., Longo, D.L., Jameson, J.L., Loscalzo, J. (Eds.). Harrison’s principles of internal medicine (18th ed.) (2011). New York: McGraw Hill.
  4. Vilacosta I, Graupner C, San Roman JA, Sarria C, Ronderos R, Fernandez C, Mancini L, Sanz O, Sanmartin JV, Stoermann W. Risk of embolization after institution of antibiotic therapy for infective endocarditis.J Am Coll Cardiol.2002; 39: 1489–1495.
  5. Nucifora G, Badano LP,Viale P,et al. Infective endocarditis in chronic haemodialysis patients: an increasing clinical challenge. Eur Heart J2007;28:2307-2312.
  6. Zhou W, Nanci V, Jean A, Salehi AH, Altuwaijri F, Cecere R, et al. Aerococcus viridans native valve endocarditis. Can J Infect Dis Med Microbiol. 2013;24(3):155-8.
  7. Uh, Y., J. S. Son, I. H. Jang, K. J. Yoon, and S. I. Hong. 2002. Penicillin-resistant Aerococcus viridans bacteremia associated with granulocytopenia. J. Korean Med. Sci. 17:113-115

 

MRI vs. CT in Diagnosing Acute Appendicitis in Children

Posted by on Sep 17, 2017 in Articles, ePubs | 0 comments

Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children: comparison with computed tomography

Author: Benjamin Whitt

Author Affiliations: Saba University School of Medicine, MA, USA

Full Text Article PDF

Corresponding Author: Benjamin Whitt, btwhitt22@gmail.com

Key Words: Appendicitis; Diagnostic Imaging; Sensitivity; Specificity; Children

Abstract:

Purpose

Computed tomography (CT) has emerged as the gold standard test for the evaluation of suspected appendicitis in pediatric patients. It has been shown to have excellent accuracy and to decrease negative appendectomy rates. However, CT scans expose patients to ionizing radiation, which is of especially high concern in children. Magnetic resonance imaging (MRI) is a potential alternative that could be used to evaluate children while eliminating exposure to radiation. This systematic review tests the hypothesis that the sensitivity and specificity of MRI are not inferior to that of CT in the evaluation of suspected appendicitis in children.

Methods

A search of the Medline database was conducted to identify articles that used MRI to evaluate children with suspected appendicitis. Articles that focused on pediatric subjects and reported sensitivity and specificity of MRI in these subjects were included. Data for the calculation of sensitivity, specificity, and 95% confidence intervals for each were extracted from each study included. Pooled data for sensitivity and specificity of MRI were calculated and tested for significance compared to sensitivity and specificity of CT using Fisher’s exact test.

Results

Nine studies were found to be relevant to the question posed by this systematic review and met the inclusion criteria. The pooled sensitivity and specificity of MRI for the diagnosis of appendicitis were 0.96 (95% CI: 0.94-0.98) and 0.97 (95% CI: 0.96-0.98) as opposed to values of 0.94 (95% CI: 0.92-0.97) and 0.95 (95% CI: 0.94-0.97) for CT. The difference between MRI and CT was not statistically significant for sensitivity (p=0.11) or specificity (p=0.06) in the evaluation of suspected appendicitis in children.

Conclusion

In children with suspected appendicitis, the sensitivity and specificity of MRI are comparable to those of CT in terms of sensitivity and specificity. MRI is a viable choice for imaging in these patients and limits exposure to radiation.

 

Published on date: September, 2017

DOI: 10.15404/msrj/07.2017.0001

Citation: Whitt, Benjamin. Systematic review of the accuracy of magnetic resonance imaging in the diagnosis of acute appendicitis in children: comparison with computed tomography, Medical Student Research Journal (2015), 4(3), 54-58. doi:10.15404/msrj/07.2017.0001

References:

  1. Guthery, S.L., Hutchings, C., Dean, J.M., & Hoff, C. (2004). National estimates of hospital utilization by children with gastrointestinal disorders: analysis of the 1997 kids’ inpatient database. The Journal of Pediatrics, 144(5), 589-94. http://dx.doi.org/10.1016/j.peds.2004.02.029
  2. Addiss, D.G., Shaffer, N., Fowler, B.S., & Tauxe, R.V. (1990). The epidemiology of appendicitis and appendectomy in the United States. American Journal of  Epidemiology, 132 (5), 910-25.
  3. Seetahal, S.A., Bolorunduro, O.B., & Sookdeo, T.C. et al. (2011). Negative appendectomy: a 10-year review of a nationally representative sample. American Journal of Surgery, 201(4), 433-7. http://dx.doi.org/10.1016/j.amjsurg.2010.10.009
  4. Saito, J.M., Yan, Y., Evashwick, T.W., Warner, B.W., & Tarr, P.I. (2013). Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis. Pediatrics, 131(1), 37-44. http://dx.doi.org/10.1542/peds.2012-1665
  5. Fahimi, J., Herring, A., Harries, A., Gonzales, R., & Alter, H. (2012). Computed tomography use among children presenting to emergency departments with abdominal pain. Pediatrics, 130(5), 1069-75. http://dx.doi.org/10.1542/peds.2012-0739
  6. Hernanz-Schulman, M. (2010). CT and US in the diagnosis of appendicitis: an argument for CT. Radiology, 255(1), 3-7. http://dx.doi.org/10.1148/radiol.2553201003
  7. Raja, A.S., Wright, C., & Sodickson, A.D. et al. (2010). Negative appendectomy rates in the era of CT: an 18-year perspective. Radiology, 256(2), 460-65. http://dx.doi.org/10.1148/radiol.10091570
  8. Charfi, S., Sellami, A., Affes, A., Yaich, K., Mzali, R., & Boudawara, T.S. (2014) Histopathological findings in appendectomy specimens: a study of 24,697 cases. International Journal of Colorectal Disease, 29(8), 1009-12. http://dx.doi.org/10.1007/s00384-014-1934-7
  9. Doria, A.S., Moineddin, R., & Kellenberger, C.J. et al. (2006). US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology, 241(1), 83-94. http://dx.doi.org/10.1148/radiol.2411050913
  10. Brenner, D.J. & Hall, E.J. (2007). Computed tomography—an increasing source of radiation exposure. New England Journal of Medicine, 357(22), 2277-84. http://dx.doi.org/10.1056/NEJMra072149
  11. Mathews, J.D., Forsythe, A.V., & Brady, Z. et al. (2013). Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians. BMJ, 346. http://dx.doi.org/10.1136/bmj.f2360
  12. Pearce, M.S., Salotti, J.A., & Little, M.P. et al. (2012). Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet, 380(9840), 499-505. http://dx.doi.org/10.1016/S0140-6736(12)60815-0
  13. Nash, K., Hafeez, A., & Hou, S. (2002). Hospital-acquired renal insufficiency. American Journal of Kidney Diseases, 39(5), 930-36. http://dx.doi.org/10.1053/ajkd.2002.32766
  14. Laroche, D., Aimone-Gastin, I., & Dubois, F. et al. (1998). Mechanisms of severe, immediate reactions to iodinated contrast material. Radiology, 209(1), 183-90. http://dx.doi.org/10.1148/radiology.209.1.9769830
  15. Cogley, J.R., O’Connor, S.C., Houshyar, R., & Al Dulaimy, K. (2012). Emergent pediatric US: what every radiologist should know. Radiographics, 32(3), 651-65. http://dx.doi.org/10.1148/rg.323115111
  16. van Randen, A., Bipat, S., Zwinderman, A.H., Ubbink, D.T., Stoker, J., & Boermeester, M.A. (2008). Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology, 249(1), 97-106. http://dx.doi.org/10.1148/radiol.2483071652
  17. Lowe, L.H., Penney, M.W., & Stein, S.M. et al. (2001). Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography. American Journal of Roentgenology, 176(1), 31-35. http://dx.doi.org/10.2214/ajr.176.1.1760031
  18. Krishnamoorthi, R., Ramarajan, N., & Wang, N.E. et al. (2011). Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology, 259(1), 231-39. http://dx.doi.org/10.1148/radiol.10100984
  19. Poletti, P.A., Platon, A., & De Perrot, T. et al. (2011). Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT. European Radiology, 21(12), 2558-66. http://dx.doi.org/10.1007/s00330-011-2212-5
  20. Rosen, M.P., Ding, A., & Blake, M.A. et al. (2011). ACR Appropriateness Criteria® right lower quadrant pain—suspected appendicitis. Journal of the American College of Radiology, 8(11), 749-55. http://dx.doi.org/10.1016/j.jacr.2011.07.010
  21. Pedrosa, I. & Rofsky, N.M. (2003). MR imaging in abdominal emergencies. Radiologic Clinics of North America, 41(6), 1243-73.
  22. Barger Jr, R.L. & Nandalur, K.R. (2010). Diagnostic performance of magnetic resonance imaging in the detection of appendicitis in adults: a meta-analysis. Academic Radiology, 17(10), 1211-16. http://dx.doi.org/10.1016/j.acra.2010.05.003
  23. Dillman, J.R., Gadepalli, S., & Sroufe, N.S. et al. (2016). Equivocal Pediatric Appendicitis: Unenhanced MR Imaging Protocol for Nonsedated Children-A Clinical Effectiveness Study. Radiology, 279(1), 216-25. http://dx.doi.org/10.1148/radiol.2015150941
  24. Thieme, M.E., Leeuwenburgh, M.M., & Valdehueza, Z.D. et al. (2014). Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis. European Radiology, 24(3), 630-37. http://dx.doi.org/10.1007/s00330-013-3044-2
  25. Herliczek, T.W., Swenson, D.W., & Mayo-Smith, W.W. (2013). Utility of MRI after inconclusive ultrasound in pediatric patients with suspected appendicitis: retrospective review of 60 consecutive patients. American Journal of Roentgenology, 200(5), 969-73. http://dx.doi.org/10.2214/AJR.12.10078
  26. Rosines, L.A., Chow, D.S., & Lampl, B.S. et al. (2014) Value of gadolinium-enhanced MRI in detection of acute appendicitis in children and adolescents. American Journal of Roentgenology, 203(5), 543-48. http://dx.doi.org/10.2214/AJR.13.12093
  27. Kulaylat, A.N., Moore, M.M., & Engbrecht, B.W. et al. (2015). An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis. Journal of Pediatric Surgery, 50(8), 1359-63. http://dx.doi.org/10.1016/j.jpedsurg.2014.12.012
  28. Moore, M.M., Gustas, C.N., & Choudhary, A.K. et al. (2012). MRI for clinically suspected pediatric appendicitis: an implemented program. Pediatric Radiology, 42(9), 1056-63. http://dx.doi.org/10.1007/s00247-012-2412-4
  29. Orth, R.C., Guillerman, R.P., Zhang, W., Masand, P., & Bisset III, G.S. (2014). Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiology, 272(1), 233-40. http://dx.doi.org/10.1148/radiol.14132206
  30. Bayraktutan, U., Oral, A., & Kantarci, M. et al. (2014). Diagnostic performance of diffusion-weighted MR imaging in detecting acute appendicitis in children: comparison with conventional MRI and surgical findings. Journal of Magnetic Resonance Imaging, 39(6), 1518-24. http://dx.doi.org/10.1002/jmri.24316
  31. Koning, J.L., Naheedy, J.H., & Kruk, P.G. (2014). Diagnostic performance of contrast enhanced MR for acute appendicitis and alternative causes of abdominal pain in Pediatric Radiology, 44(8), 948-55. http://dx.doi.org/10.1007/s00247-014-2952-x
  32. Cobben, L., Groot, I., Kingma, L., Coerkamp, E., Puylaert, J., & Blickman, J. (2009). A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy. European Radiology, 19(5), 1175-83. http://dx.doi.org/10.1007/s00330-008-1270-9
  33. Heverhagen, J.T., Pfestroff, K., Heverhagen A.E., Klose, K.J., Kessler, K., & Sitter, H. (2012). Diagnostic accuracy of magnetic resonance imaging: a prospective evaluation of patients with suspected appendicitis (diamond). Journal of Magnetic Resonance Imaging, 35(3), 617-23. http://dx.doi.org/10.1002/jmri.22854
  34. Leeuwenburgh, M.M., Wiarda, B.M., & Jensch, S. et al. (2014). Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis. European Journal of Radiology, 83(1), 103-10. http://dx.doi.org/10.1016/j.ejrad.2013.09.022

Vol 5: Winter 2017

Posted by on Jul 10, 2017 in Featured, Issues | 0 comments

Vol 5: Winter 2017

MSRJ – Volume 5 – Winter 2017

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Editorial Staff 2017-2018

Posted by on Jun 30, 2017 in Featured, Staff | 0 comments

Editorial Staff 2017-2018

Introducing the new 2017 – 2018 editorial staff for the MSRJ! We are thrilled to welcome many new junior editors to our experienced MSRJ team. The journal has been making exciting new changes with the start of e-publication and we look forward to another productive year of publishing, editing, and supporting medical student research efforts around the world!

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