Rubin S Z, Martin D J
Department of Surgery, Children's Hospital of Eastern Ontario, Ottawa, Canada.
J Pediatr Surg. 1990 Jul;25(7):737-40. doi: 10.1016/s0022-3468(05)80008-9.
One hundred thirty-four children referred to the pediatric surgical service with the diagnosis of possible acute appendicitis underwent abdominal ultrasonography within 24 hours of admission. A final diagnosis of appendicitis was made in 45, and of gynecological disease in 11 children. One child had pancreatitis, another jejunal perforation, and a third gross mesenteric lymphadenopathy. In 75 children the clinical picture completely resolved without a definitive diagnosis being made. Clinical diagnosis of gynecological disease showed two false-negatives, and three false-positives, whereas the ultrasonographic diagnosis was accurate in all patients. The sensitivity of the pediatric surgical diagnosis at the time of admission for acute appendicitis was 49% (23 false-negatives) and the specificity was 95% (three false-positives). Ultrasonographic diagnosis of appendicitis had a sensitivity of 89% (five false-negatives) and a specificity of 92% (five false-positives). There was a negative laparotomy rate of 0.7% (one patient) using both clinical evaluation and ultrasonography. These data suggest that abdominal ultrasonography in the child with possible appendicitis is an important diagnostic adjunct.
134名因可能患有急性阑尾炎而转诊至小儿外科的儿童在入院24小时内接受了腹部超声检查。最终诊断为阑尾炎的有45名儿童，诊断为妇科疾病的有11名儿童。一名儿童患有胰腺炎，另一名患有空肠穿孔，第三名患有严重的肠系膜淋巴结病。75名儿童的临床症状完全缓解，未做出明确诊断。妇科疾病的临床诊断有2例假阴性和3例假阳性，而超声诊断在所有患者中都是准确的。入院时小儿外科对急性阑尾炎诊断的敏感性为49%（23例假阴性），特异性为95%（3例假阳性）。阑尾炎的超声诊断敏感性为89%（5例假阴性），特异性为92%（5例假阳性）。同时使用临床评估和超声检查，阴性剖腹率为0.7%（1例患者）。这些数据表明，对可能患有阑尾炎的儿童进行腹部超声检查是一项重要的辅助诊断方法。
