Diagnostic value of ultrasonography and computed tomography in pathology-confirmed acute appendicitis in children

Abstract

Abstract Objective and aim: Acute appendicitis (AA), the most common cause of acute abdomen in childhood, can cause high morbidity and mortality if not diagnosed and treated on the time. 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 efficacy of abdominal ultrasonography (US) and computed tomography (CT) in the diagnosis of AA in children. Materials and methods Pediatric patients who were operated on 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. Results A total of 251 patients with a mean age of 11.3 years were included in the study. There were 154 (61.4%) males and 97 (38.6%) females. Histopathology revealed AA in 215 (85.7%) patients. Preoperatively, US and CT were performed in 139 (55.3%) and 137 (54.5%) patients, respectively. US had a sensitivity and specificity rate of 77.2% and 52.6%, respectively. Pozitive predictive value (PPV) was found to be 81.2% whereas negative predictive value (NPV) was 46.5% for US. 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. Diagnostic accuracy rate of CT was found as 81.8%. Conclusion In case of suspicion of AA, US may be the first choice because it is inexpensive, and easily accessible. However, considering the patient incompatibility and subjective factors in children, US may sometimes be unsufficient. We think that CT should be performed as an advanced examination method in cases where US is not compatible with the patient's clinic.