| Title | The diagnosis of acute appendicitis in a pediatric population: to CT or not to CT. | | Author(s) | Stephen AE, Segev DL, Ryan DP, Mullins ME, Kim SH, Schnitzer JJ, Doody DP | | Institution | Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114-2696, USA. | | Source | J Pediatr Surg 2003 Mar; 38(3):367-71; discsussion 367-71. | | MeSH | Acute Disease
Adolescent
Adult
Appendectomy
Appendicitis
Boston
Child
Child, Preschool
Contrast Media
Emergency Service, Hospital
False Negative Reactions
Female
Hospitals, University
Humans
Infant
Intestinal Perforation
Leukocyte Count
Male
Physical Examination
Predictive Value of Tests
Retrospective Studies
Tomography, X-Ray Computed
| | Abstract | PURPOSE: The aim of this study was to determine if focused appendiceal computed tomography with colon contrast (FACT-CC) increases the accuracy of the preoperative diagnosis of acute appendicitis in children.
METHODS: A 5-year retrospective review was conducted of a university hospital database of 283 patients (age 0.8 to 19.3 years; mean, 11.3 years) treated with appendectomy for presumed acute appendicitis.
RESULTS: Of the 283 patients in whom appendectomies were performed, 268 were confirmed by pathologic analysis of the specimen to have acute appendicitis for a diagnostic accuracy in our institution of 94.7%. Ninety-six patients (34%) underwent FACT-CC scans as part of their preoperative evaluation. The sensitivity of the computed tomography (CT) scan was 94.6%, and the positive predictive value was 95.6%. In girls older than 10 years, CT imaging was not significantly more accurate in predicting appendicitis than examination alone (93.9% v. 87.5%; P =.46).
CONCLUSIONS: Preoperative FACT-CC did not increase the accuracy in diagnosing appendicitis when compared with patients diagnosed by history, physical examination and laboratory studies. If there was a strong suspicion of appendicitis, a negative CT scan did not exclude the diagnosis of appendicitis. However, focused appendiceal CT scan is a sensitive test with a high positive predictive value and may be useful in a patient with an atypical history or examination. | | Language | eng | | Pub Type(s) | Journal Article
Review
| | PubMed ID | 12632351 |
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