Abstract
Background
The ability of ultrasound to identify specific features relevant to nonoperative management
of pediatric appendicitis, such as the presence of complicated appendicitis (CA) or
an appendicolith, is unknown. Our objective was to determine the reliability of ultrasound
in identifying these features.
Methods
We performed a retrospective study of children who underwent appendectomy after an
ultrasound at four children's hospitals. Imaging, operative, and pathology reports
were reviewed. Sensitivity, specificity, positive predictive value (PPV), and negative
predictive value (NPV) of ultrasound for identifying CA based on pathology and intraoperative
findings and an appendicolith based on pathology were calculated. CA was defined as
a perforation of the appendix. Equivocal ultrasounds were considered as not indicating
CA.
Results
Of 1027 patients, 77.5% had simple appendicitis, 16.2% had CA, 5.4% had no evidence
of appendicitis, and 15.6% had an appendicolith. Sensitivity and specificity of ultrasound
for detecting CA based on pathology were 42.2% and 90.4%; the PPV and NPV were 45.8%
and 89.0%, respectively. Sensitivity and specificity of ultrasound for detecting CA
based on intraoperative findings were 37.3% and 92.7%; the PPV and NPV were 63.4%
and 81.4%, respectively. Sensitivity and specificity of ultrasound for detecting an
appendicolith based on pathology were 58.1% and 78.3%; the PPV and NPV were 33.1%
and 91.0%, respectively. Results were similar when equivocal ultrasound and negative
appendectomies were excluded.
Conclusions
The high specificity and NPV suggest that ultrasound is a reliable test to exclude
CA and an appendicolith in patients being considered for nonoperative management of
simple appendicitis.
Keywords
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References
- Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial.Ann Surg. 2015; 261: 67-71
- Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis.J Pediatr Surg. 2015; 50: 1893-1897
- Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis.JAMA Surg. 2016; 151: 408-415
- Comparison of antibiotic therapy and appendectomy for acute uncomplicated appendicitis in children: a meta-analysis.JAMA Pediatr. 2017; 171: 426-434
- Efficacy and safety of nonoperative treatment for acute appendicitis: a meta-analysis.Pediatrics. 2017; 139https://doi.org/10.1542/peds.2016-3003
- Early vs interval appendectomy for children with perforated appendicitis.Arch Surg. 2011; 146: 660-665
- Initial laparoscopic appendectomy versus initial nonoperative management and interval appendectomy for perforated appendicitis with abscess: a prospective, randomized trial.J Pediatr Surg. 2010; 45: 236-240
- High failure rate of nonoperative management of acute appendicitis with an appendicolith in children.J Pediatr Surg. 2016; 51: 908-911
- Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children.J Am Coll Surg. 2014; 219: 272-279
- Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy.Pediatr Radiol. 2011; 41: 993-999
- Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- Gangrenous appendicitis in children: a prospective evaluation of definition, bacteriology, histopathology, and outcomes.J Surg Res. 2012; 177: 123-126
- Benchmarking the value of ultrasound for acute appendicitis in children.J Pediatr Surg. 2016; 51: 1939-1943
- US or CT for diagnosis of appendicitis in children and Adults? A meta-analysis.Radiology. 2006; 241: 83-94
- Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis.Pediatrics. 2013; 131: e37-e44
- Use and accuracy of diagnostic imaging in the evaluation of pediatric appendicitis.J Pediatr Surg. 2015; 50: 642-646
- Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort.Acad Emerg Med. 2013; 20: 697-702
- Management of pediatric acute appendicitis in the computed tomographic era.J Surg Res. 2008; 147: 221-224
- Accuracy of computed tomography in predicting appendiceal perforation.J Pediatr Surg. 2010; 45 (discussion 234-234): 231-234
- Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients.AJR Am J Roentgenol. 2013; 200: 957-962
- The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study?.J Pediatr Surg. 2015; 50: 923-927
- Standardized ultrasound templates for diagnosing appendicitis reduce annual imaging costs.J Surg Res. 2018; 221: 77-83
Article info
Publication history
Published online: April 16, 2018
Accepted:
March 13,
2018
Received in revised form:
February 12,
2018
Received:
November 30,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
