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CT for suspected appendicitis in children: an analysis of diagnostic errors
George A Taylor1, Michael J Callahan, Diana Rodriguez
1Department of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA. george.taylor@childrens.harvard.edu
Pediatric Radiology
|February 8, 2006
Summary
Computed tomography (CT) errors in diagnosing pediatric appendicitis are common. Pathological diagnosis, not surgical findings, should be the reference standard for accuracy in pediatric appendicitis cases.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Surgical Pathology
Background:
- Diagnostic errors occur with computed tomography (CT) in children with suspected appendicitis.
- Previous studies reported error frequency but not specific error situations.
Purpose of the Study:
- To investigate the frequency and types of diagnostic errors from CT scans in children with suspected appendicitis.
- To compare CT diagnoses with surgical and pathological findings.
Main Methods:
- Reviewed imaging, clinical, and pathological data for 1,207 pediatric patients undergoing CT for suspected appendicitis.
- Categorized imaging findings as false-positive, false-negative, or indeterminate.
- Classified errors as interpretive, technical, or unavoidable.
Main Results:
- Discrepancies between CT findings and pathological/clinical data occurred in 34 patients (2.8%).
- Interpretive errors accounted for 68% of cases, with false-positives being most common (68%).
- Common false-positive CT findings included enlarged appendix, fat stranding, and thickened bowel.
Conclusions:
- Isolated CT findings like appendicolith or enlarged appendix are insufficient for diagnosing appendicitis.
- Pathological diagnosis is a more reliable reference standard than surgical findings for true-positive CT imaging.
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