Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children
| Autor: | James E. Janik, Frederick M. Karrer, Joseph S. Janik, Denis D. Bensard, David A. Partrick |
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| Rok vydání: | 2003 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Radiography Physical examination Computed tomography Appendix Diagnosis Differential Medicine Appendectomy Humans Diagnostic Errors Child Retrospective Studies Ultrasonography medicine.diagnostic_test business.industry Ultrasound Infant Retrospective cohort study General Medicine medicine.disease Appendicitis medicine.anatomical_structure El Niño Child Preschool Pediatrics Perinatology and Child Health Surgery Female Radiology business Tomography X-Ray Computed |
| Zdroj: | Journal of pediatric surgery. 38(5) |
| ISSN: | 1531-5037 |
| Popis: | Background/Purpose: Appendicitis continues to present a diagnostic dilemma in children of all ages leading to increased utilization of radiographic studies. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. The purpose of this study was to critically evaluate the use of radiographic studies for the evaluation of acute appendicitis in children and to determine if diagnostic accuracy has improved. Methods: Children undergoing appendectomy for acute appendicitis were reviewed from 1997 to 2001. Diagnostic workup (CT scan, ultrasound [US], or no radiographic study) was recorded as were the final pathology results. Results: Six hundred sixteen appendectomies were performed. Mean age was 10.4 ± 4.1 years, and 60% were boys. Overall, 184 children (30%) underwent CT scanning, 104 (17%) had US performed, and 310 (50%) had no radiographic study (18 patients had both CT and US performed). A pathologically normal appendix was removed in 7% (14 of 202) of CT patients, 11% (14 of 122) of US patients, and 8% (26 of 310) of patients without a study. The frequency of CT scanning increased from 1.3% of all children in 1997 to 58% in 2001, whereas utilization of US decreased from 40% to 7%. Over the same period, the overall negative appendectomy rate did not change significantly from 8% to 7%. Conclusions: With increased utilization of focused CT scanning, the negative appendectomy rate has remained unchanged. History and physical examination by an experienced surgeon is as accurate as CT in correctly diagnosing acute appendicitis in children. J Pediatr Surg 38:659-662. © 2003 Elsevier Inc. All rights reserved. |
| Databáze: | OpenAIRE |
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