Ultrasound imaging in children with acute abdominal pain – can it help to decrease the rate of negative appendectomies?
Jerzy K. Niedzielski, Mieczysław Miodek, Jan Sokal, Piotr Kucharski
Med Sci Tech 2010; 51(3-4): RA221-226
Background: The purpose of this study was to evaluate the accuracy of high-resolution ultrasound (US) with graded compression in the diagnosis of pediatric appendicitis.
Material/Methods: The medical records of 664 consecutive children with acute abdominal pain treated between 2007 and 2009 were reviewed retrospectively and analyzed; 408 children (61.4%) underwent appendectomy and 256 patients were treated conservatively (38.6%). High-resolution US was performed in 570 out of 664 patients (85.8%). The US data were verified by intraoperative findings or by clinical follow-up.
Results: Out of 664 children, 408 underwent appendectomy and 256 were treated conservatively. US was performed in 570 out of 664 children (85.8%); in 327/408 children (80.1%) with AA and in 243/256 children (94.9%) with negative diagnosis. The sensitivity and specificity for US was 66.6% and 77.4%, respectively. If histopathological diagnosis of catarrhal appendicitis was considered a negative (unnecessary) appendectomy, the sensitivity was 68.6% (p=0.87), and specificity was 67% (p=0.29). Positive and negative predictive values of US were 79.9% and 63.1%, respectively. After recalculating results, positive predictive value decreased to 59.8% (p=0.036) and negative predictive value increased to 74.8% (p=0.2). The rate of false negative results was 13.1% (75/572) and the rate of false positives was 19.2% (110/572). The negative appendectomy rate was 27.4% (112/408).
Conclusions: High-resolution ultrasonography provides an accurate and specific test for acute appendicitis and is recommended by the authors as an examination of choice in children with acute abdominal pain.
Keywords: acute abdominal pain, acute appendicitis, children, ultrasonography, negative appendectomy