The diagnosis of acute appendicitis in a pediatric population: to CT or not to CT.
OBJECTIVE
The aim of this study was to determine if focused appendiceal computed tomography with colon contrast (FACT-CC) increases the accuracy of the preoperative diagnosis of acute appendicitis in children.


METHODS
A 5-year retrospective review was conducted of a university hospital database of 283 patients (age 0.8 to 19.3 years; mean, 11.3 years) treated with appendectomy for presumed acute appendicitis.


RESULTS
Of the 283 patients in whom appendectomies were performed, 268 were confirmed by pathologic analysis of the specimen to have acute appendicitis for a diagnostic accuracy in our institution of 94.7%. Ninety-six patients (34%) underwent FACT-CC scans as part of their preoperative evaluation. The sensitivity of the computed tomography (CT) scan was 94.6%, and the positive predictive value was 95.6%. In girls older than 10 years, CT imaging was not significantly more accurate in predicting appendicitis than examination alone (93.9% v. 87.5%; P =.46).


CONCLUSIONS
Preoperative FACT-CC did not increase the accuracy in diagnosing appendicitis when compared with patients diagnosed by history, physical examination and laboratory studies. If there was a strong suspicion of appendicitis, a negative CT scan did not exclude the diagnosis of appendicitis. However, focused appendiceal CT scan is a sensitive test with a high positive predictive value and may be useful in a patient with an atypical history or examination.
Stephen
Antonia E
AE
Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114-2696, USA.
Segev
Dorry L
DL
Ryan
Daniel P
DP
Mullins
Mark E
ME
Kim
Samuel H
SH
Schnitzer
Jay J
JJ
Doody
Daniel P
DP
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000453:epidemiology; D007958:Leukocyte Count; D008297:Male; D010808:Physical Examination; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
D003287:Contrast Media