E L Teo1, K P Tan, S L Lam, C L Ong, C S Wong. 1. Department of Diagnostic Imaging, Paediatric Surgery, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
Abstract
AIM: To evaluate the roles and effectiveness of US and CT in a clinical algorithm for the evaluation of children with suspected appendicitis. METHODS: Patients with suspected appendicitis were prospectively evaluated with ultrasound (US), and in some cases with CT, after they were graded to have high, intermediate or low clinical likelihood for appendicitis. Imaging findings were made known to clinicians who then decided on a line of management. Patho-histological examination and clinical follow-up established the final diagnoses, which were correlated with the imaging findings. The effect of imaging on the management of patients was examined. RESULTS: Overall, the sensitivity of US was 92.9%, specificity 96.9%, accuracy 96.0%, positive predictive value 89.7% and negative predictive value 97.9%. Imaging did not affect the decision to operate in 13/14 (92.9%) patients in the high likelihood subgroup. Imaging guided the clinicians to the right management pathway in 26/30 (86.7%) patients in the intermediate group. 77/82 (93.9%) of US was truly negative in the low likelihood group. CT was performed in 12 patients because of unsatisfactory US scans or incompatibility between the US and the clinical findings. CT correctly diagnosed the presence or absence of appendicitis in all 12 patients. CONCLUSION: US and CT are accurate modalities in the diagnosis of acute appendicitis in children. US is most useful in patients with equivocal clinical findings. US should be the first modality used to evaluate children with suspected appendicitis. CT should be reserved for cases where US is sub-optimal or where the findings are inconsistent with the clinical findings.
AIM: To evaluate the roles and effectiveness of US and CT in a clinical algorithm for the evaluation of children with suspected appendicitis. METHODS:Patients with suspected appendicitis were prospectively evaluated with ultrasound (US), and in some cases with CT, after they were graded to have high, intermediate or low clinical likelihood for appendicitis. Imaging findings were made known to clinicians who then decided on a line of management. Patho-histological examination and clinical follow-up established the final diagnoses, which were correlated with the imaging findings. The effect of imaging on the management of patients was examined. RESULTS: Overall, the sensitivity of US was 92.9%, specificity 96.9%, accuracy 96.0%, positive predictive value 89.7% and negative predictive value 97.9%. Imaging did not affect the decision to operate in 13/14 (92.9%) patients in the high likelihood subgroup. Imaging guided the clinicians to the right management pathway in 26/30 (86.7%) patients in the intermediate group. 77/82 (93.9%) of US was truly negative in the low likelihood group. CT was performed in 12 patients because of unsatisfactory US scans or incompatibility between the US and the clinical findings. CT correctly diagnosed the presence or absence of appendicitis in all 12 patients. CONCLUSION: US and CT are accurate modalities in the diagnosis of acute appendicitis in children. US is most useful in patients with equivocal clinical findings. US should be the first modality used to evaluate children with suspected appendicitis. CT should be reserved for cases where US is sub-optimal or where the findings are inconsistent with the clinical findings.
Authors: Manoj K Mittal; Peter S Dayan; Charles G Macias; Richard G Bachur; Jonathan Bennett; Nanette C Dudley; Lalit Bajaj; Kelly Sinclair; Michelle D Stevenson; Anupam B Kharbanda Journal: Acad Emerg Med Date: 2013-07 Impact factor: 3.451
Authors: David Neufeld; Michael Vainrib; Genady Buklan; Michael Gutermacher; Haim Paran; Myriam Werner; Valeria Rathause; Rivka Zissin; Ludwig Lazar; Ilan Erez Journal: Pediatr Surg Int Date: 2009-10-21 Impact factor: 1.827
Authors: Michael Vainrib; Genady Buklan; Michael Gutermacher; Ludwig Lazar; Myriam Werner; Valeria Rathaus; Ilan Erez Journal: Pediatr Surg Int Date: 2011-02-23 Impact factor: 1.827
Authors: Kuojen Tsao; Shawn D St Peter; Patricia A Valusek; Troy L Spilde; Scott J Keckler; Abhilash Nair; Daniel J Ostlie; George W Holcomb Journal: J Surg Res Date: 2008-04-08 Impact factor: 2.192