Baykara Aziz Serhat
Pediatric Surgery, Health Sciences University, Eskisehir City Hospital, Eskisehir, TUR.
Cureus. 2023 Aug 21;15(8):e43860. doi: 10.7759/cureus.43860. eCollection 2023 Aug.
Acute appendicitis (AA), the most common cause of acute abdomen in childhood, can result in significant morbidity and mortality if not diagnosed and treated in a timely manner. Diagnosis of AA is more difficult in children due to the limited communication skills, in comparison to adults. The aim of this study is to evaluate the diagnostic accuracy of abdominal ultrasonography (US) and computed tomography (CT) in the diagnosis of AA in children.
Pediatric patients who were operated on with the diagnosis of AA between January 2016 and December 2021 were retrospectively reviewed. Preoperative abdominal US and CT findings of the patients and postoperative pathology results were recorded.
A total of 263 patients with a mean age of 11.3 years were included in the study. There were 164 (62.3%) males and 99 (37.7%) females. Histopathology revealed AA in 215 (81.7%) patients. Preoperatively, US and CT were performed in 139 (52.8%) and 137 (54.5%), respectively. Both imaging methods were applied to 13 (5.1%) patients. US had a sensitivity and specificity rate of 77.2% and 52.6%, respectively. Positive predictive value (PPV) was found to be 81.2%, whereas negative predictive value (NPV) was 46.5% for US. The diagnostic accuracy rate of US was found as 70.5%. CT had a sensitivity and specificity rate of 88.1% and 57.1%, respectively. PPV was found to be 88.8%, whereas NPV was 55.1% for CT. The diagnostic accuracy rate of CT was found as 81.8%.
In case of suspicion of AA, US may be the first choice because it is inexpensive and easily accessible. However, considering patient incompatibility and subjective factors in children, US may sometimes be insufficient. We think that CT should be performed as an advanced examination method in cases where US is not compatible with the patient's condition, not clinic.
急性阑尾炎（AA）是儿童急腹症最常见的病因，如果不及时诊断和治疗，可能导致严重的发病率和死亡率。与成人相比，由于儿童沟通能力有限，AA的诊断更加困难。本研究的目的是评估腹部超声（US）和计算机断层扫描（CT）在儿童AA诊断中的诊断准确性。
回顾性分析2016年1月至2021年12月期间诊断为AA并接受手术治疗的儿科患者。记录患者术前腹部超声和CT检查结果以及术后病理结果。
本研究共纳入263例平均年龄为11.3岁的患者。其中男性164例（62.3%），女性99例（37.7%）。组织病理学显示215例（81.7%）患者为AA。术前，分别有139例（52.8%）和137例（54.5%）患者进行了超声和CT检查。13例（5.1%）患者同时接受了两种影像学检查。超声的敏感性和特异性分别为77.2%和52.6%。超声的阳性预测值（PPV）为81.2%，阴性预测值（NPV）为46.5%。超声的诊断准确率为70.5%。CT的敏感性和特异性分别为88.1%和57.1%。CT的PPV为88.8%，NPV为55.1%。CT的诊断准确率为81.8%。
怀疑AA时，超声可能是首选，因为它价格低廉且易于获得。然而，考虑到儿童患者的不配合和主观因素，超声有时可能不足。我们认为，在超声与患者病情不相符而非临床情况不相符的情况下，应将CT作为一种高级检查方法进行检查。
