Related Experiment Videos
Ultrasonography in the management of possible appendicitis in childhood
1Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.
Insights
Abdominal ultrasonography aids in diagnosing acute appendicitis in children. This imaging technique demonstrated higher accuracy than clinical diagnosis, reducing unnecessary surgeries.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
Background:
- Acute appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to prevent complications and minimize negative laparotomies.
Purpose of the Study:
- To evaluate the diagnostic accuracy of abdominal ultrasonography compared to clinical diagnosis for acute appendicitis in pediatric patients.
- To assess the impact of ultrasonography on negative laparotomy rates.
Main Methods:
- Retrospective analysis of 134 children with suspected acute appendicitis.
- Comparison of clinical diagnosis with abdominal ultrasonography findings.
- Evaluation of sensitivity, specificity, and negative laparotomy rates.
Main Results:
- Ultrasonography showed higher sensitivity (89%) and specificity (92%) for appendicitis than clinical diagnosis (49% sensitivity, 95% specificity).
- Clinical diagnosis had 2 false-negatives and 3 false-positives for gynecological disease, while ultrasonography was accurate in all cases.
- The negative laparotomy rate was significantly reduced to 0.7% with the combined use of clinical evaluation and ultrasonography.
Conclusions:
- Abdominal ultrasonography is a valuable diagnostic tool for children with suspected appendicitis.
- Incorporating ultrasonography improves diagnostic accuracy and reduces the rate of non-therapeutic laparotomies in pediatric surgical practice.
Abstract:
One hundred thirty-four children referred to the pediatric surgical service with the diagnosis of possible acute appendicitis underwent abdominal ultrasonography within 24 hours of admission. A final diagnosis of appendicitis was made in 45, and of gynecological disease in 11 children. One child had pancreatitis, another jejunal perforation, and a third gross mesenteric lymphadenopathy. In 75 children the clinical picture completely resolved without a definitive diagnosis being made. Clinical diagnosis of gynecological disease showed two false-negatives, and three false-positives, whereas the ultrasonographic diagnosis was accurate in all patients. The sensitivity of the pediatric surgical diagnosis at the time of admission for acute appendicitis was 49% (23 false-negatives) and the specificity was 95% (three false-positives). Ultrasonographic diagnosis of appendicitis had a sensitivity of 89% (five false-negatives) and a specificity of 92% (five false-positives). There was a negative laparotomy rate of 0.7% (one patient) using both clinical evaluation and ultrasonography. These data suggest that abdominal ultrasonography in the child with possible appendicitis is an important diagnostic adjunct.