Clinical versus sonographic evaluation of acute appendicitis in children: a comparison of patient characteristics and outcomes.
OBJECTIVE
Abdominal sonography has gained popularity in establishing the diagnosis of appendicitis in children with equivocal clinical presentations. However, no clear outcome benefits have been demonstrated to date. The authors conducted a retrospective study to compare the characteristics and outcomes of patients undergoing appendectomy after clinical evaluation only with those undergoing the procedure after sonography.


METHODS
The charts of 454 consecutive patients undergoing appendectomy for acute appendicitis between January 1, 1998 and December 4, 1999 were reviewed. Patients operated on after clinical evaluation only were compared with patients operated on after abdominal sonography.


RESULTS
Forty-two percent of patients (n = 191) constituted the sonography group. When compared with the clinical group, these patients had higher prevalence of female gender (52% v 38%; P =.004), longer symptom duration (2.2 +/- 2.5 v 1.6 +/- 1.6 days; P =.003), higher incidence of preoperative in-patient observation (19% v 4%; P <.001), longer duration between evaluation and operation (8.0 +/- 3.9 v 4.9 +/- 2.9 hours; P <.001), higher incidence of normal appendices on pathologic examination (13% v 6%; P =.006), and higher incidence of postoperative abscesses or phlegmons (4.4% v 1.2%; P =.04). The groups did not differ significantly in age, hospital stay, incidence of complicated appendicitis, or incidence of wound infection.


CONCLUSIONS
Patients undergoing sonography before appendectomy have a longer delay before operation, a higher rate of misdiagnosis, and more postoperative complications. Limiting sonography to truly equivocal cases and using it early in the diagnostic workup may improve outcomes in this group of patients.
Emil
S
S
Division of Pediatric General Surgery and the Department of Radiology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.
Mikhail
P
P
Laberge
J M
JM
Flageole
H
H
Nguyen
L T
LT
Shaw
K S
KS
Baican
L
L
Oudjhane
K
K
D000038:Abscess / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D002648:Child; D003951:Diagnostic Errors / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D007958:Leukocyte Count; D008297:Male; D010808:Physical Examination / Q000592:standards*; D015995:Prevalence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography / Q000592:standards*