Pastore Valentina, Cocomazzi Raffaella, Basile Angela, Pastore Marlena, Bartoli Fabio
Department of Medical and Surgical Sciences, Pediatric Surgery Unit, University of Foggia, Italy.
Afr J Paediatr Surg. 2014 Oct-Dec;11(4):293-6. doi: 10.4103/0189-6725.143130.
Graded compression ultrasonography (US) has become the most popular technique used in suspected appendicitis and in our prospective study, we have evaluated its contribution to the diagnosis of acute appendicitis during the period 2010-2013.
Four hundred and eighty children underwent urgent abdominal suspected of having acute appendicitis. Patients were divided into operated groups; (220 patients) and non-operated (260 patients) the final diagnosis was established on histopathological findings in the first group and on the phone interview in the second one. US was the sole imaging modality in all the non-operated patients and in 203 out of 220 operated ones. Seven children in the operated group underwent CT, while a second US was performed in 10 patients.
Acute appendicitis was confirmed in 188 operated patients while no one in the non-operated group returned to the hospital or was operated for appendicitis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 79%, 78%, 95%, 39% and 79%, respectively. Negative appendectomy and perforation rates were 14% and 8%. Seventeen children in the operated group required a second diagnostic imaging: 7 CTs and 10 USs. All the seven CTs were consistent with appendicitis and 6 out of 10 USs showed ecographic signs of appendicitis.
Our results support routine US in all the children with suspected appendicitis because it helps in reducing negative appendectomy and perforation rate. Moreover, a negative US does not justify a subsequent and immediate CT because clinical re-evaluation and a second US can clarify the diagnosis.
分级加压超声检查（US）已成为疑似阑尾炎最常用的技术，在我们的前瞻性研究中，我们评估了其在2010年至2013年期间对急性阑尾炎诊断的贡献。
480名疑似患有急性阑尾炎的儿童接受了紧急腹部检查。患者被分为手术组（220例患者）和非手术组（260例患者），第一组根据组织病理学结果确定最终诊断，第二组通过电话访谈确定。超声是所有非手术患者以及220例手术患者中的203例的唯一成像方式。手术组中有7名儿童接受了CT检查，10名患者进行了第二次超声检查。
188例手术患者确诊为急性阑尾炎，而非手术组中无人因阑尾炎返回医院或接受手术。敏感性、特异性、阳性预测值、阴性预测值和准确性分别为79%、78%、95%、39%和79%。阴性阑尾切除率和穿孔率分别为14%和8%。手术组中有17名儿童需要进行第二次诊断性成像：7次CT检查和10次超声检查。所有7次CT检查结果均与阑尾炎一致，10次超声检查中有6次显示有阑尾炎的超声征象。
我们的结果支持对所有疑似阑尾炎的儿童进行常规超声检查，因为它有助于降低阴性阑尾切除率和穿孔率。此外，超声检查结果为阴性并不意味着需要立即进行后续CT检查，因为临床重新评估和第二次超声检查可以明确诊断。
