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

Abstract

Background

To determined the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard.

Methods

A 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.

Results

Of 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.

Conclusions

In 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 design

cross sectional validation.

Highlights

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  Total 223 Diagnose as acute appendicitis on initial clinical basis and follow by ultrasound study.

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  All went for surgery, 8 patient negative by histopathology.

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  Diagnosis by ultrasound 192 out of 223, Sensitivity 86%.

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  Accuracy reaches 92% with secondary signs on ultrasound finding.