To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

Abstract

BackgroundTo determined the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard.MethodsA prospective evaluations of all ultrasound for appendicitis from January 1, 2014, to June 15, 2017, was conducted at our hospital. A diagnostic protocol was implemented to reduce radiation exposure employing US as the initial imaging modality followed by CT for non-diagnostic US studies in patients with an equivocal clinical presentation. The imaging, operative findings, and pathology of 223 patients (females 80, males 143, age less than 14years) with diagnosed appendicitis were collected. The sensitivity, specificity, predictive value, and negative appendectomy rate were also analyzed. All those patients which had subjected to surgery were included to evaluate the true result of ultrasound in diagnosis of appendicitis.ResultsOf the 223 pediatric appendectomies performed in this time period, a total of 192 (86%) were diagnosed by ultrasound. The histopathology of 8 was normal (3.6%), CT done in 11 and three was normal. The negative appendectomy rate was 3.6%. US were the sole imaging modality in all patients.ConclusionsIn the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure.Study designcross sectional validation.

The Modified Heidelberg and the AI Appendicitis Score Are Superior to Current Scores in Predicting Appendicitis in Children: A Two-Center Cohort Study

“…US is found to be the most cost-effective diagnostic approach in children with suspected appendicitis (34). The drawback of US is that its application can potentially delay surgical treatment and its diagnostic value is quite dependent on the experience of the user (29,30,32,35). In this current and in previous studies, the embedding of US in the diagnostic algorithms or scoring system, improved sensitivity, and specificity (30).…”

“…In our cohort, US demonstrating appendicitis seems to be one of the best predicting factors for appendicitis in children with abdominal pain. US has been used to aid diagnosing acute appendicitis since the 1980s and has already been evaluated extensively in pediatric populations (29)(30)(31)(32)(33). US is found to be the most cost-effective diagnostic approach in children with suspected appendicitis (34).…”

Ultrasonogram in Acute Appendicitis, A Surgeon’s Perspective: Original Article

“…Further an anxious patient may not allow the examination for the fear of pain, especially a crying child. The drawback of this is usually a sonogram being reported as "Appendix not visualised" or "no evidence of Acute Appendicitis" [10,13]. In such situations the patients as well as surgeons prefer to wait and watch sometimes ignoring the need for surgery.…”

Reply to: Validity of ultrasound in predicting acute appendicitis among children, keeping histopathology as gold standard: Methodological issues

“…Thank you for this interest in our paper, we hope this reply will be helpful in regard to your valuable comments [1].…”

“…The aim of our study was to determine the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard [1]. A few limitations of our study are worth mentioning, first we could not capture all the population going through ultrasound for that given period, due to patients seen by emergency staff, missing negative predictive value (NPV) in our study.…”