Scientific Papers
Selective use of ultrasonography for acute appendicitis in children

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Abstract

Background: To evaluate the role of ultrasonography in children with equivocal signs of acute appendicitis, and correlate with initial clinical impression and pathological findings.

Methods: This is a prospective evaluation of all children presenting with a possible diagnosis of appendicitis during a 14-month study period. Patients with unequivocal clinical signs of appendicitis underwent appendectomy without ultrasonography. Patients with equivocal signs had documentation of the clinical impression and subsequent abdominal ultrasound. Statistical analysis of results was performed using the chi-square test (P <0.05 significant).

Results: Two hundred fifteen consecutive children were enrolled. Signs were unequivocal in 116 and equivocal in 99. Seven patients in the first group had a normal appendix at operation. Of the 99 patients with equivocal signs, there were 28 true positives, 3 false positives, 64 true negatives, and 4 false negatives. In equivocal cases, sensitivity of the initial clinical impression versus ultrasound was 50% and 88%, respectively (P <0.05). Specificity was 85% and 96%, respectively. The positive and negative predictive values improved from 63% to 90% and 78% to 94%, respectively, with the use of ultrasonography.

Conclusions: The low false positive rate (6%) in clinically obvious cases of appendicitis does not, in our opinion, warrant ultrasonography. In clinically equivocal cases, ultrasonography is a fast, sensitive, and specific diagnostic modality to diagnose or rule out appendicitis, avoiding the need for prolonged observation and/or hospitalization.

Section snippets

Materials and methods

This is a prospective study, performed over a 14-month period. During this time, all consecutive children suspected of having acute appendicitis were considered. On initial evaluation by a pediatric surgeon, patients were placed into three categories: I, acute appendicitis unequivocally; II, equivocal for appendicitis; or III, unequivocally without acute appendicitis. Patients in category III were not enrolled in the study, were not admitted to the pediatric surgery service, and none to our

Results

Of the 116 patients who presented with unequivocal signs of appendicitis, all underwent appendectomy. Seven of the removed appendices were histologically normal. Thus, the false positive rate for patients with unequivocal signs of appendicitis based on clinical findings alone was 6%.

The 99 patients who presented without the classic signs and symptoms of appendicitis underwent ultrasound. Prior to this, initial clinical impression was recorded; it was positive for appendicitis in 26 patients. Of

Comments

The child presenting with abdominal pain is one of the most common pediatric complaints. The diagnosis of acute appendicitis is often straightforward, based on classic history and clinical findings. However, patients are sometimes subjected to periods of observation to confirm or rule out the diagnosis of acute appendicitis. For fear of missing the diagnosis and allowing the development of perforation, peritonitis, and sepsis, a low index of suspicion and early operative intervention have been

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