Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, SA, Australia.
Department of Paediatric Surgery, Women's and Children's Hospital, Adelaide, SA, Australia.
J Pediatr Surg. 2024 Feb;59(2):235-239. doi: 10.1016/j.jpedsurg.2023.10.028. Epub 2023 Oct 20.
Acute appendicitis may present a diagnostic dilemma. The aim of this study was to review the accuracy of ultrasound in the diagnosis of paediatric acute appendicitis.
Ultrasound studies performed for investigation of appendicitis during 2015-2021 were retrieved from a tertiary paediatric hospital database and reviewed. Medical records were reviewed to determine operative intervention, further imaging, and final diagnosis. Diagnostic accuracy was assessed by sensitivity, specificity, predictivity, and overall accuracy. All appendicectomy specimens underwent histopathological confirmation. This study was approved by the local Human Research Ethics Committee.
A total of 8555 consecutive ultrasound examinations were performed during the study period. Mean patient age was 10.8 years ( ± 3.7). Overall diagnostic accuracy was 96.1% (8221/8555) with a visualisation rate of 91.0%. Sensitivity and specificity were 96.2% (CI 95.3-97.0%) and 96.1% (CI 95.6-96.5%), respectively. When limited to positive/negative scans, sensitivity was 99.6% (CI 99.2-99.8%) and specificity 99.0% (CI 98.7-99.3%). Positive and negative predictive values were 96.9% and 99.9%, respectively. Repeat ultrasound following a non-diagnostic scan led to a definitive diagnosis in 76.1%. Negative appendicectomy rate was 5.5% overall in children who had undergone pre-operative ultrasound (107/1938), and 4.4% when other surgical pathologies were excluded.
Ultrasound examination provides gold-standard accuracy in the diagnosis of paediatric appendicitis and reduces rates of negative appendicectomy. Given the disadvantages of computed tomography and magnetic resonance imaging, ultrasound should be considered the first-line investigation of choice in the diagnosis of acute appendicitis in children.
III.
急性阑尾炎可能存在诊断上的困难。本研究旨在回顾超声在儿科急性阑尾炎诊断中的准确性。
从一家三级儿科医院的数据库中检索了 2015 年至 2021 年期间因阑尾炎进行的超声检查，并对其进行了回顾。查阅病历以确定手术干预、进一步影像学检查和最终诊断。通过敏感性、特异性、预测值和总准确性评估诊断准确性。所有阑尾切除标本均行组织病理学证实。本研究得到了当地人类研究伦理委员会的批准。
在研究期间共进行了 8555 次连续超声检查。患者平均年龄为 10.8 岁（±3.7）。总体诊断准确性为 96.1%（8221/8555），可视化率为 91.0%。敏感性和特异性分别为 96.2%（95.3-97.0%）和 96.1%（95.6-96.5%）。当仅限于阳性/阴性扫描时，敏感性为 99.6%（99.2-99.8%），特异性为 99.0%（98.7-99.3%）。阳性和阴性预测值分别为 96.9%和 99.9%。对非诊断性扫描进行重复超声检查后，76.1%的患者可明确诊断。在接受术前超声检查的 1938 例儿童中，阴性阑尾切除率总体为 5.5%（107/1938），排除其他外科病理后为 4.4%。
超声检查在儿科阑尾炎的诊断中提供了金标准的准确性，并降低了阴性阑尾切除率。鉴于计算机断层扫描和磁共振成像的缺点，超声检查应被视为儿童急性阑尾炎诊断的首选一线检查方法。
III 级。
