Suspected appendicitis in children: rectal and intravenous contrast-enhanced versus intravenous contrast-enhanced CT
Anupam B Kharbanda1, George A Taylor, Richard G Bachur
1Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Mass., USA. ak493@columbia.edu
Insights
In children suspected of appendicitis, both intravenous contrast-enhanced computed tomography (CT) and CT with both intravenous and rectal contrast showed similar diagnostic performance. This finding suggests that simpler CT protocols may be sufficient for evaluating pediatric appendicitis.
Area of Science:
- Radiology
- Pediatric Imaging
- Diagnostic Performance Evaluation
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to avoid complications and unnecessary surgery.
- Computed tomography (CT) is frequently used for diagnosing appendicitis in pediatric patients.
Purpose of the Study:
- To compare the diagnostic performance of intravenous contrast-enhanced CT versus intravenous and rectal contrast-enhanced CT in children with suspected appendicitis.
- To determine if adding rectal contrast improves CT accuracy for pediatric appendicitis diagnosis.
Main Methods:
- Retrospective study of 416 pediatric patients (aged 5-21) with suspected appendicitis.
- Comparison of intravenous contrast-enhanced CT (n=193) with intravenous and rectal contrast-enhanced CT (n=223).
- Diagnostic performance metrics (sensitivity, specificity, accuracy, predictive values) were compared using pathological, surgical, or follow-up data as reference.
Main Results:
- Both CT techniques demonstrated high diagnostic performance without significant differences.
- Intravenous and rectal contrast CT: 92% sensitivity, 87% specificity, 89% accuracy.
- Intravenous contrast CT alone: 93% sensitivity, 92% specificity, 92% accuracy.
- No significant difference in accuracy (P > .2) between the two CT protocols.
Conclusions:
- Intravenous contrast-enhanced CT offers comparable diagnostic performance to intravenous and rectal contrast-enhanced CT for evaluating pediatric appendicitis.
- The addition of rectal contrast does not significantly improve diagnostic accuracy in this pediatric population.
- Simpler CT protocols using only intravenous contrast may be sufficient for diagnosing appendicitis in children.
Purpose:
To retrospectively compare the diagnostic performance of intravenous contrast material-enhanced computed tomography (CT) with that of intravenous and rectal contrast-enhanced CT in the evaluation of children suspected of having appendicitis by using pathologic findings, surgical findings, or a follow-up telephone call as the reference standard.
Materials And Methods:
This HIPAA-compliant study was approved by the committee on clinical investigations. As part of a larger study, informed consent was obtained from all parents and from all children older than 7 years. Consecutive patients aged 5-21 years who presented to the emergency department and were suspected of having appendicitis were studied with CT. From April 2003 until February 2004, patients underwent intravenous and rectal contrast-enhanced CT. From March 2004 until December 2004, patients underwent intravenous contrast-enhanced CT. Demographic data, clinical outcomes, and test performance characteristics--including sensitivity, specificity, accuracy, and negative and positive predictive values--were compared.
Results:
Of the 416 patients who met inclusion criteria, 223 underwent intravenous and rectal contrast-enhanced CT and 193 underwent intravenous contrast-enhanced CT. There were no differences in sex distribution (55% vs 52% male patients), frequency of appendicitis (36% vs 32%), or frequency of equivocal CT findings (4%) between the groups. Intravenous and rectal contrast-enhanced CT had a sensitivity of 92% (95% confidence interval [CI]: 85%, 97%), a specificity of 87% (95% CI: 79%, 92%), a negative predictive value of 94% (95% CI: 90%, 98%), and an accuracy of 89% (95% CI: 85%, 93%). Intravenous contrast-enhanced CT had a sensitivity of 93% (95% CI: 84%, 97%), a specificity of 92% (95% CI: 85%, 96%), a negative predictive value of 95% (95% CI: 90%, 99%), and an accuracy of 92% (95% CI: 88%, 96%) (P > .2 for all comparisons).
Conclusion:
There was no significant difference between the performance of intravenous contrast-enhanced CT and that of rectal and intravenous contrast-enhanced CT in children suspected of having appendicitis.
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