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CT of appendicitis in children
Michael J Callahan1, Diana P Rodriguez, George A Taylor
1Department of Radiology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
Insights
Diagnosing appendicitis in children is difficult, but helical computed tomography (CT) significantly improves accuracy. This imaging technique reduces unnecessary surgeries and lowers costs for pediatric patients.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Appendicitis is the most common surgical emergency in children, but diagnosis is challenging, especially in young children.
- Missed diagnosis rates for acute appendicitis in children under 12 range from 28-57%, and nearly 100% in those under 2.
- Diagnostic imaging plays a crucial role in the accurate and timely diagnosis of pediatric appendicitis.
Purpose of the Study:
- To describe a helical computed tomography (CT) imaging approach for children with suspected appendicitis.
- To evaluate the impact of this helical CT approach on patient outcomes and hospital costs.
Main Methods:
- Helical computed tomography (CT) with rectally administered contrast material was used as the primary diagnostic tool.
- The study was conducted at a large urban pediatric teaching hospital.
Main Results:
- Helical CT is a highly sensitive and specific tool for diagnosing pediatric appendicitis.
- This approach led to a beneficial change in patient care for 68.5% of patients.
- It reduced inpatient observation days, negative laparotomies, and per-patient costs.
Conclusions:
- Helical CT with rectal contrast is effective in diagnosing appendicitis in children.
- This method aids in diagnosing alternative causes of abdominal pain and improves patient care.
- The study highlights the significant role of helical CT in managing pediatric appendicitis.
Abstract:
Appendicitis is the most common condition requiring intraabdominal surgery in infancy and childhood. Yet, despite its common occurrence, accurate diagnosis remains challenging. Acute appendicitis may be missed at initial clinical examination in 28%-57% of children aged 12 years and younger and in nearly 100% of children under the age of 2 years. Diagnostic imaging has an ever-increasing role in the prompt and accurate diagnosis of acute appendicitis in the pediatric population. At the authors' institution, helical computed tomography (CT) is the primary tool for diagnosing or excluding appendicitis in children. Since its inception in 1998, helical CT with rectally administered contrast material has been shown to reduce the total number of inpatient observation days, laparotomies with negative findings, and per-patient cost. Helical CT is a highly sensitive and specific tool for diagnosing pediatric appendicitis and has resulted in a beneficial change in patient care in 68.5% of all patients seen in the authors' emergency department for suspected appendicitis. This includes both those patients who receive an eventual diagnosis of appendicitis and those who do not have the disease. Major strengths of limited helical CT with rectal contrast material include producing uniformly high published sensitivity and specificity values for diagnosis of appendicitis and enabling diagnosis of alternative conditions of acute abdominal pain in children. In contrast, limitations of graded-compression ultrasonography in children include highly operator-dependent sensitivity and specificity values and relative infrequency with which the normal appendix can be visualized in this population. Although there have been many exciting diagnostic advancements for the diagnosis of acute appendicitis in the pediatric population, the role of helical CT is far from clear. The purpose of this article is to describe a helical CT approach to imaging in children suspected of having acute appendicitis at a large urban pediatric teaching hospital and its effects on patient outcomes and hospital costs.