Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging
Acute appendicitis in children: comparison of clinical diagnosis with ultrasound and CT imaging
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DOI：
10.1007/s002470050023
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发表时间：
2000-02-01
影响因子：
2.3
通讯作者：
Singh, SP
中科院分区：
文献类型：
--
作者：
Karakas, SP;Guelfguat, M;Singh, SP
背景有强有力的证据表明，超声和CT成像在儿童急性阑尾炎的诊断中具有重要的诊断价值，但有关成像对这些患者的管理及其对手术结果的可能影响的信息有限。我们研究了影像学在急性阑尾炎治疗中的作用，特别是它对阴性阑尾切除术和穿孔率的影响。我们回顾性分析了633例临床疑似急性阑尾炎的儿童和青少年的临床记录和影像学表现。270例患者仅根据临床证据进行了手术，而360例患者因临床发现可疑而进行了超声或CT检查，有时两者都进行。其中237例仅因临床原因发现急性阑尾炎，其中68例有穿孔和相关并发症。阴性探查率为13%，穿孔率为29%. 182名患者术前进行了US检查（灵敏度74%，特异性94%），119名患者进行了CT检查（灵敏度84%，特异性99%），59名患者同时进行了US和CT检查（灵敏度75%，特异性100%，但通常相互解释不一致）。超声检查的阴性阑尾切除率和穿孔率分别为8%和23%，CT检查为5%和54%，两种检查均进行时为9%和71%。超声、CT或二者联合检查的诊断率之间以及各组阴性阑尾切除率之间均无统计学意义，但单独或超声检查后行CT检查的阑尾穿孔率明显较高。本研究的回顾性性质妨碍了对可能有助于疑似急性阑尾炎儿童管理的诊断性检查的临床特征和选择标准的精确定义。然而，它的目的是反映这些患者的诊断方法和管理，在许多决策者和影像学检查的解释者的照顾下，今天在大多数医院为基础的临床实践中普遍存在。这表明，成像提高诊断准确性在困难的情况下，但它可能是一个因素，增加穿孔率。
Background. There is strong evidence that imaging with ultrasound and CT can be of substantial diagnostic value in the diagnosis of acute appendicitis in children, but there is limited information of the impact of imaging on the management of these patients and its possible effect on surgical findings.Objective. We studied the impact of imaging in the management of acute appendicitis, in particular its effect on the rate of negative appendectomies and perforations.Patients and methods. We reviewed retrospectively the clinical records and imaging findings of 633 consecutive children and adolescents seen on an emergency basis with clinical suspicion of acute appendicitis. Two hundred seventy patients were operated upon on clinical evidence alone, while 360 were referred for US or CT, and occasionally both, because of doubtful clinical findings.Results. Acute appendicitis was found in 237 of those on clinical grounds alone, 68 of whom had perforation and related complications. Thus the rate of negative exploration and the rate of perforation were 13 % and 29 %, respectively. One hundred eighty-two patients had preoperative US (sensitivity 74 %, specificity 94 %), 119 had CT (sensitivity 84 %, specificity 99 %), and 59 had both US and CT (sensitivity 75 %, specificity 100 %, but often with interpretation at variance with each other). The rate of negative appendectomy and perforation was 8 % and 23 %, respectively, for US, 5 % and 54 % for CT, and 9 % and 71% when both examinations were performed. There is no statistical significance between the rates of diagnostic performance of US, CT, or their combination, nor between the negative appendectomy rates of each group, but the rate of perforation was significantly higher when CT was performed, alone or after US.Conclusion. The retrospective nature of the study prevents precise definition of the clinical characteristics and selection criteria for diagnostic examinations that may contribute to the management of children with suspected acute appendicitis. It was designed, however, to reflect the diagnostic approach and management of these patients, under the care of many decision makers and interpreters of imaging examinations, prevalent today in most hospital-based clinical practices. It is suggested that imaging increases diagnostic accuracy in difficult cases, but it might be one of the factors increasing the rate of perforations.