Suspected Appendicitis in Children: US and CT— A Prospective Randomized Study

Abstract

US is valuable in the diagnosis of appendicitis in children. In inconclusive cases, performing additional abdominal CT can improve diagnostic accuracy and thereby decrease the negative appendectomy rate without an increase in the perforation rate.

Population-based cohort study on the epidemiology of acute appendicitis in children in Sweden in 1987-2013

“…Ultrasonography, and subsequently CT, was introduced for diagnosing appendicitis in adults in the late 1980s 12 . In Stockholm, Kaiser and colleagues13 reported the outcome of the introduction of ultrasonography and CT for diagnosing acute appendicitis in children, finding stable incidence rates during the introduction. Most importantly, the increased incidence rates in the present study were transient, proving that, in the long term, the introduction of ultrasonography and CT did not increase the incidence rate of diagnosed acute appendicitis in children.…”

“…Novel diagnostic modalities including ultrasonography and CT have been introduced12 13. More expectant strategies regarding the treatment of acute appendicitis have gradually been adopted, replacing previous standards of performing emergency surgery in all patients with suspected appendicitis, accepting a high rate of negative appendicectomy to avoid possible perforation14 15.…”

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

“…Equivocal appendicitis (2) Normal appendix (2) Acute gastroenteritis (1) a Pelvic inflammatory disease (1) a Equivocal appendicitis (3) Acute appendicitis (3) Serositis (1) Nonperforated appendicitis (2) Nonperforated appendicitis (1) Perforated appendicitis (1) Perforated appendicitis (1) Perforated appendicitis (1) Appendiceal cancer (1) Mucinous cystadenocarcinoma (1) Normal appendix and ascites (2) Normal appendix and hemoperitoneum Suspected ovarian cystic rupture (2) a with ovarian cyst (2) Normal appendix and pericecal fluid collection (1) Normal appendix and diverticulitis (1) Diverticulitis (1) a a These diagnoses were based on nonsurgical outcomes.…”

“…1 In previous studies of these diagnostic techniques, the sensitivities and specificities of sonography were 67% to 88% and 78% to 100%, respectively, whereas the sensitivities and specificities of CT were 76% to 96% and 75% to 95%. [2][3][4][5][6] Hye Soo Koo, MD, Hyun Cheol Kim, MD, Dal Mo Yang, MD, Sang Won Kim, MD, Seong Jin Park, MD, Jung Kyu Ryu, MD Received December 17, 2012, Objectives-The purpose of this study was to evaluate the additional value of supplementary computed tomography (CT) after sonography for diagnosing acute appendicitis.Methods-Among 140 consecutive patients with suspected acute appendicitis who underwent both initial sonography and supplementary CT within 12 hours, 88 patients whose appendices could not be visualized on sonography were excluded. The remaining 52 patients (mean age, 37.3 years; range, 15-98 years) were enrolled in this study.…”

“…[2][3][4][5][6] In a prospective study that reported a head-to-head comparison of sonography and CT in acute appendicitis, the sensitivity of CT (94%) was higher than that of sonography (76%). 7 However, because of radiation exposure during CT, recent studies have suggested performing initial sonography and limiting CT in patients with acute abdominal pain.…”