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Ultrasonography of acute abdominal pain in children
M J Siegel1, C Carel, S Surratt
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo. 63110-1076.
Insights
Ultrasonography effectively detects appendicitis in children. It also helps diagnose other causes of acute abdominal pain, proving useful when clinical diagnosis is uncertain.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Emergency Medicine
Background:
- Acute abdominal pain is a common presentation in pediatric emergency departments.
- Diagnosing appendicitis in children can be challenging based on clinical criteria alone.
- Alternative diagnoses for abdominal pain in children are numerous and varied.
Purpose of the Study:
- To evaluate the diagnostic accuracy of ultrasonography for appendicitis in children.
- To assess the utility of ultrasonography in identifying alternative causes of acute abdominal pain in pediatric patients.
- To determine the role of ultrasonography when clinical evaluation for appendicitis is inconclusive.
Main Methods:
- A cohort study was conducted involving 178 pediatric patients with suspected appendicitis.
- Ultrasonography was performed, and results were compared with final diagnoses from surgery or clinical data.
- The study assessed the sensitivity and specificity of ultrasonography for appendicitis and its ability to detect other conditions.
Main Results:
- Ultrasonography correctly identified appendicitis in 82% of surgically confirmed cases.
- In children without appendicitis, ultrasonography aided in diagnosing other conditions in 59% of cases.
- No false-positive results for appendicitis were reported; however, a significant portion of patients had pain of unknown origin.
Conclusions:
- Ultrasonography is a valuable tool for diagnosing appendicitis in children.
- The imaging modality assists in identifying alternative diagnoses for acute abdominal pain in pediatric populations.
- Ultrasonography improves diagnostic certainty in cases where clinical assessment is insufficient.
Objective:
--To determine the ability of ultrasonography to detect appendicitis and to identify other conditions responsible for symptoms in children with acute abdominal pain.
Design:
--Cohort study. The accuracy of ultrasonographic results was assessed in relation to final diagnoses established by surgery or by composite clinical data and follow-up.
Setting:
--Metropolitan, pediatric hospital; ambulatory and hospitalized patients.
Patients:
--Consecutive sample of 178 pediatric patients who were referred for ultrasonography because of suspected acute appendicitis, but in whom the diagnosis could not be definitively established by clinical criteria.
Results:
--Appendicitis was proven at surgery in 38 patients. Ultrasonography demonstrated the findings of appendicitis (noncompressible appendix with or without concomitant periappendiceal fluid collection or appendicolith) in 31 (82%) of these patients. Among the 140 children without appendicitis, other specific diagnoses were established by clinical, laboratory, and radiologic findings in 58 patients (including gynecologic diseases in 25, gastrointestinal tract abnormalities in 17, renal diseases in six, and extra-abdominal disease in 10). Ultrasonography aided in the diagnosis of other conditions in 34 (59%) of these 58 patients. No definitive clinical diagnosis was established in the remaining 82 patients. There were no false-positive results of ultrasonography.
Conclusion:
--Approximately half of children referred for suspected appendicitis will have a final diagnosis of abdominal pain of unknown origin. In the remainder, ultrasonography is useful, both to establish the diagnosis of appendicitis and to aid in diagnosing other causes of acute abdominal pain.