BACKGROUND:
Appendicitis is the commonest surgical emergency in pediatric patients. Although the diagnosis is mainly clinical, imaging studies can be used to enhance diagnosis. Ultrasound is widely used as a screening tool because it is readily accessible in most centers, cost effective, and radiation free, but still there is a percentage of (equivocal study), so searching for secondary inflammatory sonographic signs may enhance the diagnosis.
AIM OF STUDY:
To assess the role of secondary sonographic signs in diagnosis of acute appendicitis in pediatric patients.
PATIENTS & METHOD:
This is a prospective study involved 187 patients (121 males, 66 females) done in Baghdad Medical city/ Children Welfare Teaching Hospital /Pediatric Surgery department between November 2018 and November 2019, all presented with abdominal pain mainly at right iliac fossa, patients sent for abdominal ultrasound, complete blood count, urinalysis, and histopathological examination of surgical specimens.
RESULTS:
Secondary signs have sensitivity of 53.7%, specificity of 80.0%, PPV of 97.9%, NPV of 8.9%, and accuracy of 55.1%.
There is significant statistical difference in rate of detecting SS (p-value=0.038).
CONCLUSION:
Secondary signs have high specificity but fair or low sensitivity. Multiple secondary signs in one patient make the ultrasound more valuable in diagnosis.
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- Sivit CJ, Applegate KE, Stallion A, et al. Imaging evaluation of suspected appendicitis in a pediatric population. Am J Roentgenol2000; 175: 977–80. [PubMed] [Google Scholar]
- Wiersma F, Toorenvliet BRB, Bloem JJL, Allema JH, Holscher HC. US examination of the appendix in children with suspected appendicitis: the additional value of secondary signs. Eur Radiol2009; 19: 455–61. [PubMed] [Google Scholar]
- Gracey D, McClure MJ. The impact of ultrasound in suspected acute appendicitis. Clin Radiol2007; 62: 573–78. [PubMed] [Google Scholar]
- Baldisserotto M, Marchiori E. Accuracy of noncompressive sonography of children with appendicitis according to the potential positions of the appendix. AJR Am J Roentgenol2000;175: 1387–92. [PubMed] [Google Scholar]
- Dilley A, Wesson D, Munden M, et al. The impact of ultrasound examinations on the management of children with suspected appendicitis: a 3‐year analysis. J Pediatr Surg 2001; 36:303–8. [PubMed] [Google Scholar]
- Limchareon S, Wongsuttilert A, Boonyarit A. Efficacy of ultrasonography in evaluation of suspected appendicitis in pediatric population. J Med Ultrasound2014; 22:213–17. [Google Scholar]
- Reed MH. Imaging utilization commentary: a radiology perspective. Pediatr Radiol 2008; 38: 660–3. [PubMed] [Google Scholar]
- Lee JH. Sonography of acute appendicitis. Semin Ultrasound CT MRI2003; 24: 83–90. [PubMed] [Google Scholar]
- Lee MW, Kim YJ, Jeon HJ, Park SW, Jung SI, Yi JG. Sonography of acute right lower quadrant pain: importance of increased intraabdominal fat echo. Am J Roentgenol 2009;192:174–79. [PubMed] [Google Scholar]
- Hahn HB, Hoepner FU, Kalle TV, et al. Sonography of acute appendicitis in children: 7 years' experience. Pediatr Radiol 1998;28:147–51. [PubMed] [Google Scholar]
- Sivit CJ, Siegel MJ, Applegate KE, et al. Special Focus Session. When appendicitis is suspected in children. Radiographics 2001;21:247-262.
- Ozel, A, Orhan UP, Akdana B, et al. Sonographic appearance of the normal appendix in children. J Clin Ultrasound 2011;39:183-86.
- Lee JH, Jeong YK, Park KB, et al. Operator-dependent techniques for Graded compression sonography to detect the appendix and diagnose acute appendicitis. Am J Roentgenol 2005;184:91-97.
- Kessler N, Cyteval C, Gallix B, et al. Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology 2004;230:472-78.
- Tulin-Silver S, Babb J, Pinkney L, et al. The challenging ultrasound diagnosis of perforated appendicitis in children: constellations of sonographic findings improve specificity. Pediatr Radiol 2014 December 4; epub ahead of print. DOI 10.1007/s00247-014-3232-5.
- Jacob L, Incidence and Significance of Inconclusive Results in Ultrasound for Appendicitis in Children and Teenagers. Canadian Association of Radiologists Journal 2011:page 197-202
- Ross et al. Outcomes of children with suspected appendicitis and incompletely visualized appendix on ultrasound. 2014 by the Society for Academic Emergency Medicine. doi: 10.1111/acem.12377.
- Mirza W A, Naveed M Z, Khandwala K (December 27, 2018) Utility and Accuracy of Primary and Secondary Ultrasonographic Signs for Diagnosing Acute Appendicitis in Pediatric Patients. Cureus 10(12): e3779. DOI 10.7759/cureus.3779
- Estey A, Poonai N, Lim R. Appendix not seen: the predictive value of secondary inflammatory sonographic signs. Pediatr Emerg Care. 2013;29:435-39.
- Nielsen JW, Boomer L, Kurtovic K, et al. Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg. 2015;50:144–48.
- Sarah M. Coyne, Does Appendiceal Diameter Change With Age? A Sonographic Study, American Journal of Roentgenology. 2014:
-
- Held JM, McEvoy CS, Auten JD, Foster SL, Ricca RL. The non-visualized appendix and secondary signs on ultrasound for pediatric appendicitis in the community hospital setting. Pediatr Surg Int. 2018;34:1287-92.
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