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Clinical validity of ultrasound in children with suspected appendicitis
1Emergency Medicine Residency Program, Butterworth Hospital, Grand Rapids.
Insights
Graded compression ultrasonography accurately diagnoses appendicitis in children, showing 85% sensitivity and 94% specificity. This imaging technique offers reliable results for pediatric appendicitis diagnosis.
Area of Science:
- Pediatric Imaging
- Diagnostic Ultrasound
- Abdominal Emergencies
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to avoid complications and unnecessary surgery.
- Diagnostic imaging plays a key role in evaluating suspected appendicitis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of graded compression ultrasonography for appendicitis in pediatric patients.
- To determine the sensitivity and specificity of ultrasound in diagnosing appendicitis in children.
Main Methods:
- Retrospective case review of 98 children with suspected appendicitis.
- Inclusion of patients aged 2-12 years undergoing graded compression sonography.
- Analysis of medical records, sonographic findings, surgical outcomes, and follow-up data.
Main Results:
- Ultrasound demonstrated 85% sensitivity and 94% specificity for appendicitis.
- Overall diagnostic accuracy was 91.8% (90/98 children).
- False positives included ileitis and Meckel's diverticulum; false negatives were not detailed.
Conclusions:
- Graded compression ultrasonography is an accurate diagnostic tool for pediatric appendicitis.
- The diagnostic performance in children is comparable to that reported in adults.
- Ultrasound can be reliably used to diagnose appendicitis in the pediatric population.
Study Objective:
To determine the accuracy of diagnosing appendicitis in the pediatric population by using graded compression ultrasonography.
Design:
Retrospective case review.
Setting:
University-affiliated community hospital with an emergency department census of approximately 19,000 pediatric visits per year.
Type Of Participants:
Ninety-eight children (age less than 13 years) with clinically suspected appendicitis who had graded compression sonographic studies during the 24-month study period.
Interventions:
Medical records were reviewed for patient demographics, presenting signs and symptoms, sonographic findings, surgical results, and hospital course. Patients who did not undergo surgery were followed up by telephone for a minimum of two months.
Results:
Ninety-eight children (42 boys and 56 girls; age range, 2 to 12 years; mean age, 8.0 years) with clinical signs and symptoms of acute appendicitis were examined sonographically. Of the 26 patients whose appendicitis was verified at surgery, ultrasound was positive in 22, with an overall sensitivity of 85%. Of the 72 patients who did not have appendicitis, ultrasound was negative in 68, with a specificity of 94%. Two patients with false-positive ultrasound went to surgery and were found to have acute ileitis and perforated Meckel's diverticulum. The overall diagnostic accuracy was 91.8% (90 of 98).
Conclusion:
Use of ultrasound to diagnose acute appendicitis was performed with a sensitivity of 85% and a specificity of 94%. This allows the same accuracy in children as has been reported with adults.