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[Diagnostic surplus value of echography in children with acute abdominal pain]
E D van den Ende1, W P Boellaard, J H Allema
1Afd. Heelkunde, Iuliana Kinderziekenhuis/Rode Kruis Ziekenhuis, Sportlaan 600, 2566 MJ Den Haag.
Insights
Ultrasound (echography) significantly improves the accuracy of diagnosing acute abdominal pain in children, increasing diagnostic specificity and reducing unnecessary surgeries.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Abdominal Surgery
Background:
- Acute abdominal pain is a common presentation in pediatric emergency departments.
- Accurate diagnosis is crucial to guide appropriate management and surgical intervention.
Purpose of the Study:
- To evaluate the diagnostic utility of echography (ultrasound) in children presenting with acute abdominal symptoms.
- To determine if echography enhances the accuracy of clinical diagnosis in this population.
Main Methods:
- A prospective, descriptive study was conducted over one year.
- Abdominal ultrasonography was performed on 112 children with acute abdominal pain.
- Radiologists were blinded to initial clinical diagnoses; final diagnoses were confirmed by histology or clinical outcome.
Main Results:
- Echography, combined with clinical findings, improved diagnostic specificity from 70% to 91% compared to clinical findings alone (88% sensitivity).
- The positive predictive value increased from 69% to 88% with the addition of echography.
- Acute appendicitis was diagnosed in 48 children.
Conclusions:
- Echography provides significant added value in diagnosing acute abdominal pain in children.
- It enhances the specificity of physical examinations and reduces the rate of negative laparotomies.
- Ultrasonography is a valuable tool for pediatric abdominal pain evaluation.
Objective:
To assess the role of echography in the diagnosis of acute abdominal symptoms in children.
Design:
Prospective, descriptive.
Method:
During one year (1 June 1999-31 May 2000), abdominal ultrasonography was performed in all children with abdominal pain less than 2 weeks, who were referred to the emergency department of the Red Cross Hospital in The Hague (the Netherlands). An initial clinical diagnosis was made on the basis of the medical history, a physical examination and the results of laboratory tests. Subsequently, ultrasonography was performed by a radiologist who was unaware of the clinical diagnosis. A working hypothesis was reached on the basis of the clinical findings and the results of echography. The final diagnosis was made on the basis of either a histologic investigation after surgery or the condition at discharge.
Results:
The study included 112 patients. The mean age was 9 years and 54% were boys. Acute appendicitis was ascertained in 48 children. The sensitivity of the clinical findings was 88% and the specificity 70%. The sensitivity of the clinical findings together with ultrasonography was 88% and the specificity 91%. The positive predictive value of the clinical findings alone was 69% and of the clinical findings together with ultrasonography 88%.
Conclusion:
Echography has added value in the diagnosis of acute abdominal pain in children; it increases the specificity of the physical examination. The number of negative laparotomies was decreased by the use of ultrasonography.