The diagnosis of acute appendicitis in a pediatric population: to CT or not to CT

J Pediatr Surg. 2003 Mar;38(3):367-71; discsussion 367-71. doi: 10.1053/jpsu.2003.50110.

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.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Appendectomy
  • Appendicitis / diagnosis*
  • Appendicitis / diagnostic imaging
  • Appendicitis / surgery
  • Boston / epidemiology
  • Child
  • Child, Preschool
  • Contrast Media
  • Emergency Service, Hospital / statistics & numerical data
  • False Negative Reactions
  • Female
  • Hospitals, University / statistics & numerical data
  • Humans
  • Infant
  • Intestinal Perforation / diagnostic imaging
  • Intestinal Perforation / epidemiology
  • Leukocyte Count
  • Male
  • Physical Examination
  • Predictive Value of Tests
  • Retrospective Studies
  • Tomography, X-Ray Computed* / statistics & numerical data

Substances

  • Contrast Media