Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis
Introduction: Acute appendicitis in children is a clinical diagnosis, which often requires preoperative confirmation with either ultrasound (US) or computed tomography (CT) studies. CTs expose children to radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2015-12-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/4xn4d6d8 |
| _version_ | 1817998408906964992 |
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| author | Danielle I. Miano Renee M. Silvis Jill M. Popp Marvin C. Culbertson Brendan Campbell Sharon R. Smith |
| author_facet | Danielle I. Miano Renee M. Silvis Jill M. Popp Marvin C. Culbertson Brendan Campbell Sharon R. Smith |
| author_sort | Danielle I. Miano |
| collection | DOAJ |
| description | Introduction: Acute appendicitis in children is a clinical diagnosis, which often requires preoperative
confirmation with either ultrasound (US) or computed tomography (CT) studies. CTs expose children to
radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric population
with appropriate clinical follow up and serial exam may be an effective diagnostic modality for many
children without incurring the risk of radiation. The objective of the study was to compare the rate of
appendiceal rupture and negative appendectomies between children with and without abdominal CTs;
and to evaluate the same outcomes for children with and without USs to determine if there were any
associations between imaging modalities and outcomes.
Methods: We conducted a retrospective chart review including emergency department (ED) and inpatient
records from 1/1/2009–2/31/2010 and included patients with suspected acute appendicitis.
Results: 1,493 children, aged less than one year to 20 years, were identified in the ED with suspected
appendicitis. These patients presented with abdominal pain who had either a surgical consult or an
abdominal imaging study to evaluate for appendicitis, or were transferred from an outside hospital or
primary care physician office with the stated suspicion of acute appendicitis. Of these patients, 739 were
sent home following evaluation in the ED and did not return within the subsequent two weeks and were
therefore presumed not to have appendicitis. A total of 754 were admitted and form the study population,
of which 20% received a CT, 53% US, and 8% received both. Of these 57%, 95% CI [53.5,60.5] had
pathology-proven appendicitis. Appendicitis rates were similar for children with a CT (57%, 95% CI
[49.6,64.4]) compared to those without (57%, 95% CI [52.9,61.0]). Children with perforation were similar
between those with a CT (18%, 95% CI [12.3,23.7]) and those without (13%, 95% CI [10.3,15.7]).
The proportion of children with a negative appendectomy was similar in both groups: CT (7%, 95% CI
[2.1,11.9]), US (8%, 95% CI [4.7,11.3]) and neither (12%, 95% CI [5.9,18.1]).
Conclusion: In this uncontrolled study, the accuracy of preoperative diagnosis of appendicitis and
the incidence of pathology-proven perforation appendix were similar for children with suspected acute
appendicitis whether they had CT, US or neither imaging, in conjunction with surgical consult. The
imaging modality of CT was not associated with better outcomes for children presenting to the ED with
suspected appendicitis. |
| first_indexed | 2024-04-14T02:53:15Z |
| format | Article |
| id | doaj.art-154d674a52cb4ec88ba831f89fc166b6 |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-04-14T02:53:15Z |
| publishDate | 2015-12-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-154d674a52cb4ec88ba831f89fc166b62022-12-22T02:16:12ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182015-12-0116797498210.5811/westjem.2015.10.25576Abdominal CT Does Not Improve Outcome for Children with Suspected Acute AppendicitisDanielle I. Miano0Renee M. Silvis1Jill M. Popp2Marvin C. Culbertson3Brendan Campbell4Sharon R. Smith5Connecticut Children’s Medical Center, Department of Research, Hartford, ConnecticutConnecticut Children’s Medical Center, Department of Research, Hartford, ConnecticutConnecticut Children’s Medical Center, Department of Research, Hartford, ConnecticutConnecticut Children’s Medical Center, Department of Emergency Medicine, Hartford, ConnecticutConnecticut Children’s Medical Center, Department of Surgery, Hartford, ConnecticutConnecticut Children’s Medical Center, Department of Emergency Medicine, Hartford, ConnecticutIntroduction: Acute appendicitis in children is a clinical diagnosis, which often requires preoperative confirmation with either ultrasound (US) or computed tomography (CT) studies. CTs expose children to radiation, which may increase the lifetime risk of developing malignancy. US in the pediatric population with appropriate clinical follow up and serial exam may be an effective diagnostic modality for many children without incurring the risk of radiation. The objective of the study was to compare the rate of appendiceal rupture and negative appendectomies between children with and without abdominal CTs; and to evaluate the same outcomes for children with and without USs to determine if there were any associations between imaging modalities and outcomes. Methods: We conducted a retrospective chart review including emergency department (ED) and inpatient records from 1/1/2009–2/31/2010 and included patients with suspected acute appendicitis. Results: 1,493 children, aged less than one year to 20 years, were identified in the ED with suspected appendicitis. These patients presented with abdominal pain who had either a surgical consult or an abdominal imaging study to evaluate for appendicitis, or were transferred from an outside hospital or primary care physician office with the stated suspicion of acute appendicitis. Of these patients, 739 were sent home following evaluation in the ED and did not return within the subsequent two weeks and were therefore presumed not to have appendicitis. A total of 754 were admitted and form the study population, of which 20% received a CT, 53% US, and 8% received both. Of these 57%, 95% CI [53.5,60.5] had pathology-proven appendicitis. Appendicitis rates were similar for children with a CT (57%, 95% CI [49.6,64.4]) compared to those without (57%, 95% CI [52.9,61.0]). Children with perforation were similar between those with a CT (18%, 95% CI [12.3,23.7]) and those without (13%, 95% CI [10.3,15.7]). The proportion of children with a negative appendectomy was similar in both groups: CT (7%, 95% CI [2.1,11.9]), US (8%, 95% CI [4.7,11.3]) and neither (12%, 95% CI [5.9,18.1]). Conclusion: In this uncontrolled study, the accuracy of preoperative diagnosis of appendicitis and the incidence of pathology-proven perforation appendix were similar for children with suspected acute appendicitis whether they had CT, US or neither imaging, in conjunction with surgical consult. The imaging modality of CT was not associated with better outcomes for children presenting to the ED with suspected appendicitis.http://escholarship.org/uc/item/4xn4d6d8AppendicitisCTemergency |
| spellingShingle | Danielle I. Miano Renee M. Silvis Jill M. Popp Marvin C. Culbertson Brendan Campbell Sharon R. Smith Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis Western Journal of Emergency Medicine Appendicitis CT emergency |
| title | Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis |
| title_full | Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis |
| title_fullStr | Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis |
| title_full_unstemmed | Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis |
| title_short | Abdominal CT Does Not Improve Outcome for Children with Suspected Acute Appendicitis |
| title_sort | abdominal ct does not improve outcome for children with suspected acute appendicitis |
| topic | Appendicitis CT emergency |
| url | http://escholarship.org/uc/item/4xn4d6d8 |
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