Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study

Abstract

Purpose To prospectively evaluate the diagnostic performance of ultrasonography (US) for differentiating perforated from nonperforated pediatric appendicitis and to investigate the association between specific US findings and perforation. Materials and Methods This HIPAA-compliant study had institutional review board approval, and the need for informed consent was waived. All abdominal US studies performed for suspected pediatric appendicitis at one institution from July 1, 2013, to July 9, 2014, were examined prospectively. US studies were reported by using a risk-stratified scoring system (where a score of 1 indicated a normal appendix; a score of 2, an incompletely visualized normal appendix; a score of 3, a nonvisualized appendix; a score of 4, equivocal; a score of 5a, nonperforated appendicitis; and a score of 5b, perforated appendicitis). The diagnostic performance of US studies designated 5a and 5b was calculated. The following US findings were correlated with perforation at multivariate analysis: maximum appendiceal diameter, wall thickness, loss of mural stratification, hyperemia, periappendiceal fat inflammation, periappendiceal fluid, lumen contents, and appendicolith presence. The number of symptomatic days prior to presentation was recorded. Surgical diagnosis and clinical follow-up served as reference standards. Results A total of 577 patients with a diagnosis of appendicitis at US met the study criteria (468 with a score of 5a; 109 with a score of 5b). Appendicitis was correctly identified in 573 (99.3%) of 577 patients. US performance in the detection of perforated appendicitis (5b) was as follows: a sensitivity of 44.0% (80 of 182), a specificity of 93.1% (364 of 391), a positive predictive value of 74.8% (80 of 107), and a negative predictive value of 78.1% (364 of 466). Statistically significant associations with perforated appendicitis were longer duration of symptoms (odds ratio [OR] = 1.46, P < .0001), increased maximum diameter (OR = 1.29, P < .0001), simple periappendiceal fluid (OR = 2.08, P = .002), complex periappendiceal fluid (OR = 18.5, P < .0001), fluid-filled lumen (OR = 0.34, P = .002), and appendicolith (OR = 1.67, P = .02). Conclusion US is highly specific but nonsensitive for perforated pediatric appendicitis. Several US findings are significantly associated with perforation, especially the presence of complex periappendiceal fluid. RSNA, 2016.

Predictive value of serum sodium level in determining complicated appendicitis risk in children

“…Ultrasound is the most commonly used imaging method for diagnosis of acute appendicitis. However, in the differentiation of simple and perforated appendicitis, it is reported that the specificity of ultrasound is high, but its sensitivity is low [9,10] . There are several studies on the diagnostic value of laboratory tests performed to differentiate perforated appendicitis from simple appendicitis.…”

Diagnostic performance of ultrasound to differentiate perforated from non‐perforated paediatric appendicitis: A narrative review

“…The studies reviewed (Table 1) show that ultrasound has high specificity ranging from 90% to 100%, but low sensitivity ranging from 23% to 44% to distinguish perforated paediatric appendicitis (Table 2) 39,40,42,43 and indicate that the use of a scoring system may be beneficial (Table 3). 42 Sonographic findings with high specificity but low sensitivity to differentiate perforated from non-perforated paediatric appendicitis include the presence of an abscess 7,38 loculated or complex intraperitoneal fluid, 38,43 the presence of an appendicolith, 7,38 dilated bowel 38 and wall thickening of the terminal ileum 43 (Table 4).…”

“…3 The literature explores the diagnostic performance and findings of ultrasound for differentiating perforated from non-perforated paediatric appendicitis and demonstrates that ultrasound is a useful first-line imaging choice to exclude perforated appendicitis in children. 7,[38][39][40]42,43 4.1 | Diagnostic performance of ultrasound…”

Is it possible to diagnose perforative appendicitis in children with ultrasound?

“…2) виявлений у 27 (27,8%) дітей, яких оперували з приводу гострого апендициту, а при перфоративному апендициті його виявили у 11 (37,9%) пацієнтів. Тоді як дані літератури свідчать, що наявність копроліту (апендиколіту) є одним із чинників перфорації відростка [4,15], а за даними E. Blumfield та співавт. (2013), наявність апендиколіту у дітей молодше 8 років має чутливість 68% і специфічність 92% щодо наявності перфоративного апендициту [3].…”