Division of Pediatric Surgery, Department of Surgery, New York University Medical Center, New York, NY 10016, USA.
J Pediatr Surg. 2012 Dec;47(12):2268-72. doi: 10.1016/j.jpedsurg.2012.09.018.
To assess the efficacy and accuracy of ultrasonography (US) and selective computed tomography (CT) in the diagnosis of acute appendicitis in children.
A retrospective review of all ultrasound evaluations for appendicitis from July 1, 2003, to June 30, 2010, was conducted at two urban pediatric centers. Beginning in 2003, a multi-disciplinary 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 802 patients (365 females, 437 males, age less than 18 years) with suspected appendicitis were reviewed. The sensitivity, specificity, predictive value, and negative appendectomy rate of the protocol were analyzed. A telephone survey was conducted of patients discharged without a diagnosis of appendicitis to evaluate the missed appendicitis rate.
Of the 601 pediatric appendectomies performed, a total of 275 (46%) were diagnosed by protocol. The selective protocol had a sensitivity of 94.2%, specificity of 97.5%, positive predictive value of 95.2%, and negative predictive value of 97.0%. The negative appendectomy rate was 1.82%, and the missed appendicitis rate was 0%. No patient discharged after only ultrasound evaluation without undergoing surgery reported missed appendicitis on the survey (41.7% response rate). Protocol use increased from 6.7% to 88.3%. US was the sole imaging modality in 630 of all 802 patients (78.6%).
US followed by selective CT for the diagnosis of acute appendicitis is useful and accurate. This has important implications in the reduction of childhood radiation exposure.
评估超声（US）和选择性计算机断层扫描（CT）在儿童急性阑尾炎诊断中的疗效和准确性。
对 2003 年 7 月 1 日至 2010 年 6 月 30 日期间在两个城市儿科中心进行的所有超声阑尾炎评估进行回顾性分析。自 2003 年起，采用多学科诊断方案，减少辐射暴露，将 US 作为初始成像方式，对于临床表现不确定的患者，在非诊断性 US 研究后采用 CT。回顾了 802 例（365 名女性，437 名男性，年龄小于 18 岁）疑似阑尾炎患者的影像学、手术和病理结果。分析了该方案的敏感性、特异性、预测值和阴性阑尾切除率。对未诊断为阑尾炎出院的患者进行电话调查，以评估漏诊阑尾炎的发生率。
在 601 例儿科阑尾切除术中，共有 275 例（46%）通过方案诊断。选择性方案的敏感性为 94.2%，特异性为 97.5%，阳性预测值为 95.2%，阴性预测值为 97.0%。阴性阑尾切除率为 1.82%，漏诊阑尾炎率为 0%。仅接受超声评估而未手术的患者在调查中无一人报告漏诊阑尾炎（41.7%的应答率）。方案使用率从 6.7%增加到 88.3%。802 例患者中，630 例（78.6%）仅行 US 作为单一影像学检查。
US 后选择性 CT 诊断急性阑尾炎既有用又准确。这对于减少儿童辐射暴露具有重要意义。
