A Retrospective Comparison Study of Ultrasonography and Computed Tomography Scan in Diagnosis of Acute Appendicitis in the Pediatric Population

Abstract

Background: Ultrasonography (US) has largely become the primary diagnostic imaging modality for the diagnosis of acute appendicitis (AA) in pediatric patients. The purpose of this study was to determine and compare the diagnostic accuracy of helical computed tomography (CT) scans and graded compression US for the diagnosis of AA in the pediatric population.

Methods: Between January 2011 and December 2013, 431 pediatric patients (aged 5 - 18 years) who presented with acute abdominal pain and received either a CT scan, US, or both for the diagnosis of AA were retrospectively reviewed from an IRB-approved institution-wide database. Sensitivities and specificities of both imaging modalities were calculated and compared.

Results: Patients were allocated into two cohorts depending on whether they received an US (239/431) or CT (192/431). Clinical symptoms and laboratory values were noted and analyzed for the significance of mesenteric lymphadenitis in conjunction with appendicitis and for differential diagnosis. A total of 182 CT cases and 227 US cases were verified as appendicitis via histopathology report. The overall sensitivity and specificity of CT imaging were determined to be 91.2% and 70%, respectively, while the sensitivity and specificity for US imaging were 52.8% and 83.3%.

Conclusion: Helical CT imaging in the pediatric population has provided a higher sensitivity and diagnostic accuracy for AA. However, the diagnostic benefit of US cannot be excluded in this patient population. Further research is needed on whether CT imaging should be used primarily for the diagnostic approach to AA in pediatric patients complaining of acute abdominal pain.

J Curr Surg. 2020;10(3):21-27
doi: https://doi.org/10.14740/jcs404