B. C. Weber3, K. G. Gill2, E. L. Riedesel2, R. S. Cartmill4, C. M. Leys1, J. E. Kohler1 1University Of Wisconsin,Pediatric Surgery,Madison, WI, USA 2University Of Wisconsin,Pediatric Radiology,Madison, WI, USA 3University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA 4University Of Wisconsin,Wisconsin Surgical Outcomes Research Program,Madison, WI, USA
Introduction: Acute appendicitis is one of the leading causes of surgery in children. Recent clinical trials suggest that simple acute appendicitis in pediatric patients can often be successfully treated non-operatively with antibiotics. Conversely, perforated appendicitis requires urgent appendectomy or percutaneous drainage and a prolonged course of antibiotics. As treatment strategies for perforated and simple acute appendicitis diverge, effective imaging to identify the presence or absence of perforation preoperatively is increasingly important. Ultrasound has a demonstrated effectiveness in diagnosing acute appendicitis, but its ability to detect perforation has not been well elucidated.
Methods: We retrospectively analyzed health records of all pediatric patients who presented to a single pediatric Emergency Department with suspected appendicitis from 11/1/2014 to 12/31/2015. We abstracted data from radiology reports, operative notes, and pathology reports to determine the effectiveness of ultrasound at predicting perforated appendicitis based on concordance of ultrasound and surgical findings. We used the only evidence-based definition for perforation that is associated with an increased risk of abscess formation, a hole in the appendix or fecalith in the abdomen at the time of operation.
Results: A total of 480 ultrasounds for suspected appendicitis were performed during the study period. 85.6% of patients with appendicitis were successfully diagnosed using ultrasound. Of these 95 patients, 28 (29.5%) were perforated at operation and 67 (70.5%) were not perforated. The interpreting pediatric radiologist’s impression of perforation was correct 81.1% of the time with a specificity of 86.6% and sensitivity of 67.9%.
Conclusion: These data suggest that ultrasound is a reliable measure for identifying appendicitis and perforation in children with a sensitivity and specificity comparable to reports for computed tomography (CT) scans. The negative predictive value of ultrasound for perforation should allow safe attempts at non-operative management of appendicitis if perforation is not seen.
