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Ultrasonography as an adjunct in the diagnosis of acute appendicitis: a 4-year experience
P Ramachandran1, C J Sivit, K D Newman
1Department of Surgery, Children's National Medical Center, Washington, D.C. 20010, USA.
Insights
Abdominal ultrasonography is a highly sensitive and specific tool for diagnosing appendicitis in children. This study confirms its accuracy, making it a valuable addition to standard diagnostic methods for acute appendicitis.
Area of Science:
- Pediatric Radiology
- Diagnostic Imaging
- Surgical Pathology
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate diagnosis is crucial to prevent complications.
- Traditional diagnostic methods can have limitations.
Purpose of the Study:
- To evaluate the diagnostic performance of abdominal ultrasonography for appendicitis in pediatric patients.
- To determine the sensitivity, specificity, and accuracy of graded compression ultrasonography.
- To compare diagnostic yield between initial and selective ultrasonography use.
Main Methods:
- A retrospective analysis of 452 children with suspected appendicitis.
- Graded compression ultrasonography using a 5.0-MHz linear array transducer.
- Correlation of sonographic findings with surgical and pathological outcomes.
Main Results:
- Overall sensitivity was 90%, specificity 96%, and accuracy 95%.
- Diagnostic performance was consistent across different study periods and patient groups.
- False-negative rate was low (2.4%) with no significant morbidity; false-positive rate was 2.4%.
Conclusions:
- Abdominal ultrasonography demonstrates high accuracy in diagnosing appendicitis in children.
- It serves as a reliable adjunct to clinical examination and other diagnostic tools.
- Ultrasonography can effectively aid in the management of pediatric appendicitis cases.
Abstract:
This study was designed to evaluate the sensitivity and specificity of abdominal ultrasonography as a diagnostic modality in a large series of children who presented with possible appendicitis. From August 1990 to July 1994, 452 children (203 boys, 249 girls) with an average age of 11 years (range, 1 to 20 years) underwent graded compression ultrasonography of the right lower quadrant of the abdomen for the evaluation of possible appendicitis. In the first 18 months of the study all patients with the possible diagnosis of appendicitis (group I; 180 patients) had abdominal ultrasonography after members of the surgical team evaluated and documented their findings in the medical record. In the second study period (30 months), abdominal ultrasonography was recommended only when the clinical diagnosis of acute appendicitis was equivocal (group II; 272 patients). Abdominal ultrasonography was performed using the graded compression technique with a 5.0-MHz linear array transducer. A positive ultrasound study for appendicitis was defined as the presence of an enlarged noncompressible appendix with an outer wall to outer wall diameter of greater than 6 mm, the presence of a complex mass, or the presence of an appendicolith. The sonographic data were correlated with surgical and pathological findings. Appendicitis was confirmed in 112 of the 452 cases. In 17 of these, the appendix was perforated. In the overall group of 452 children, abdominal ultrasonography had a sensitivity of 90%, specificity of 96%, and accuracy of 95%. There was no significant morbidity in the 11 patients with a false-negative study result. All 11 patients had an uncomplicated appendectomy. There were 11 false-positive results; 10 of these patients had a negative laparotomy result (negative laparatomy rate, 8.9%). For the two groups, the sensitivity and specificity of ultrasonography in the diagnosis of appendicitis were equivalent (group 1: 88% sensitivity, 96% specificity; group 2: 92% sensitivity, 97% specificity). On the basis of the high sensitivity and specificity rates, ultrasonography of the appendix can be a useful adjunct to standard examination in the diagnosis of acute appendicitis.