Background: Acute appendicitis may present a diagnostic dilemma. The aim of this study was to review the accuracy of ultrasound in the diagnosis of paediatric acute appendicitis.
Method: Ultrasound studies performed for investigation of appendicitis during 2015-2021 were retrieved from a tertiary paediatric hospital database and reviewed. Medical records were reviewed to determine operative intervention, further imaging, and final diagnosis. Diagnostic accuracy was assessed by sensitivity, specificity, predictivity, and overall accuracy. All appendicectomy specimens underwent histopathological confirmation. This study was approved by the local Human Research Ethics Committee.
Results: A total of 8555 consecutive ultrasound examinations were performed during the study period. Mean patient age was 10.8 years ( ± 3.7). Overall diagnostic accuracy was 96.1% (8221/8555) with a visualisation rate of 91.0%. Sensitivity and specificity were 96.2% (CI 95.3-97.0%) and 96.1% (CI 95.6-96.5%), respectively. When limited to positive/negative scans, sensitivity was 99.6% (CI 99.2-99.8%) and specificity 99.0% (CI 98.7-99.3%). Positive and negative predictive values were 96.9% and 99.9%, respectively. Repeat ultrasound following a non-diagnostic scan led to a definitive diagnosis in 76.1%. Negative appendicectomy rate was 5.5% overall in children who had undergone pre-operative ultrasound (107/1938), and 4.4% when other surgical pathologies were excluded.
Conclusion: Ultrasound examination provides gold-standard accuracy in the diagnosis of paediatric appendicitis and reduces rates of negative appendicectomy. Given the disadvantages of computed tomography and magnetic resonance imaging, ultrasound should be considered the first-line investigation of choice in the diagnosis of acute appendicitis in children.
Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.jpedsurg.2023.10.028 | DOI Listing |
Andes Pediatr
October 2024
Cirugía Pediátrica, Hospital Roberto del Río, Santiago, Chile.
Unlabelled: Acute appendicitis (AA) is the most frequent cause of acute surgical abdomen in pediatrics. During the COVID-19 pandemic, lockdown slowed surgical processes, delaying medical consultations.
Objective: To analyze the impact of the pandemic on the presentation and management of acute appendicitis.
CRSLS
January 2025
Department of Surgery, King Saud University Medical City, Riyadh, Saudi Arabia. (Drs. Aljunaydil, Mattar, Almufawaz, AlOthman, and Alalem).
Introduction: Acute appendicitis and acute cholecystitis are two of the most commonly encountered surgical entities. Multiple hypotheses are behind their coexistence, which include pathogen predilection, and mucosal ischemia inducing portal vein bacteremia as the management of uncomplicated acute cholecystitis and acute appendicitis is surgical, for which a single operation for synchronous presentation is effective. Here, we report a case with coexistent acute cholecystitis and acute appendicitis managed at our institution.
View Article and Find Full Text PDFAcad Emerg Med
January 2025
Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Background: Diagnostic stewardship is the effort to optimize diagnostic testing to reduce errors while avoiding overtesting and overtreatment. Abdominal pain and appendicitis in children are essential use cases. Delayed diagnosis of appendicitis can be dangerous and even life-threatening, but overtesting is harmful.
View Article and Find Full Text PDFCurr Med Imaging
January 2025
Medical Imaging Department, King Abdullah Medical Complex, Jeddah, Saudi Arabia.
Background: Perforation is one of the rarest effects of Meckel's diverticulum and may clinically resemble acute appendicitis.
Case Report: A 34-year-old woman with pain in the right iliac fossa, nausea, and vomiting for three days was brought to the emergency department. An abdominal examination indicated rebound tenderness in the area of the right iliac fossa.
J Surg Res
January 2025
Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio. Electronic address:
Introduction: Child Opportunity Index (COI) is associated with complicated appendicitis (CA) in children. Value-based care through an accountable care organization (ACO) may modify this association. We aimed to determine if enrollment in our state's ACO, Partners For Kids (PFK), modified the association between COI and CA.
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