Médecine d'urgence: libre accès
Libre accès

Abstrait

The Accuracy of Computed Tomography (CT) and Ultrasound (US) in the Diagnosis of Acute Appendicitis in Pediatrics: A Retrospective Comparative Study

Daehwan Kim, Kyuwhan Jung, Sio Ann Cherry, Hyejin Jang and Mi-Ok Yoon

Purpose: The aim of this study was to determine if US is an accurate imaging modality in determining the preoperative diagnosis of acute appendicitis compared to CT and to assess the accuracy of US as the primary imaging modality.
Methods: A retrospective review of all US and CT evaluations for appendicitis from January 2003 to December 2012 was conducted in our institution. All patients who underwent appendectomy were included. From these patients, we documented who underwent ultrasonography or CT scan for their preoperative workup and noted the diagnoses made based on the imaging modality done. We retrospectively documented the subjects' demographic data (age, sex, body weight, type of operation and pathologic finding).
Results: There were 1117 consecutive patients in our study. Among them, 65 patients were excluded because of lack of preoperative imaging and record of the body weight. A total of 1052 patients were evaluated. Of these patients, 25 (2.3%) patients had a negative appendectomy, 14 patients (2.6%) performed US and 11 patients performed CT for preoperative imaging workup. There was no statistical difference between those who underwent US and CT with negative appendectomy. The ROC curve was constructed based on the pathologic result of appendectomy. The AUC for US and CT was 0.666 and 0.778, respectively. However, the difference between them was reduced after adjusting sex, age and BW, as US (0.739) and CT (0.801) for which there is no statistical difference (p=0.366). The relevance of diagnosis was acceptable using co-efficient analysis which constructed based on a pathology result, both US and CT (p<0.001).
Conclusions: The diagnostic accuracy of preoperative US did not decrease the accuracy on diagnosis of acute appendicitis in children when compared with CT. US is a sensitive test and is useful on diagnosis of acute appendicitis in children, with the advantage of avoiding radiation exposure.