Update on appendicitis: diagnosis and presurgical management.
OBJECTIVE
Practitioners who see pediatric patients with acute complaints are commonly faced with making the diagnosis of appendicitis. While sometimes the history and physical examination are sufficient, frequently some diagnostic confirmation will be necessary. While diagnostic imaging is frequently useful, it may not be easily obtained. Blood tests are more readily available, with less cost and risk, but unclear diagnostic accuracy. Other questions for the initial examiner are when to consult the surgeon and if analgesia administration will obscure the diagnosis.


RESULTS
Abdominal computed tomography scans and ultrasound scans have been shown to be accurate in the diagnosis of acute appendicitis. The literature has begun to focus on which patients should undergo imaging studies. Several clinical decision rules that may be helpful in identifying low-risk patients have been derived. Analgesia given before establishing a diagnosis does not appear to change outcomes.


CONCLUSIONS
A careful history and physical examination will identify a minority of pediatric appendicitis cases. When diagnostic testing is needed, computed tomography scanning has the best test performance, but also carries the risk of radiation. Elimination of a portion of low-risk patients may reduce unnecessary imaging.
Friday
Janet H
JH
Department of Pediatrics, University of California and Children's Hospital, Health Center, San Diego, California, USA. jfriday@chsd.org
D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D001065:Appendix / Q000000981:diagnostic imaging*; D002648:Child; D006801:Humans; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography