Journal List > J Korean Assoc Pediatr Surg > v.19(2) > 1015930

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Jun: Usefulness of Preoperative Computed Tomography in Children with Clinically Suspected Appendicitis
Original Article

Journal of the Korean Association of Pediatric Surgeons 2013; 19(2): 57-65.

Published online: 24 December 2013

DOI: https://doi.org/10.13029/jkaps.2013.19.2.57

Usefulness of Preoperative Computed Tomography in Children with Clinically Suspected Appendicitis

Si-Youl Jun, M.D.

Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Correspondence: Si-Youl Jun, M.D., Department of Surgery, Samsung Changwon Hospital, 50 Hapsung Dong, Changwon 630-723, Korea. Tel: 055)290-6014, Fax: 055)290-6584, ncnanmc1205@naver.com

Received 6 May 2013       Accepted 6 August 2013

Copyright © 2013 Korean Association of Pediatric Surgeons

Abstract

The entity of negative appendectomies still poses a dilemma in chlidren. Focused computed tomography (CT) scanning has become the diagnostic test of choice in many hospitals. However, the impact of CT scans on the diagnosis in children is unknown exactly. The purpose of this study was to critically evaluate CT scans for the evaluation of acute appendicitis in children, to review utilization of this diagnostic test in our appendicitis population and to determine if diagnostic accuracy has improved. A retrospective analysis of efficacy of CT scan for diagnosis of appendicitis in children was conducted. Children undergoing appendectomy for acute appendicitis were reviewed from 2007 to 2012. Perforation and negative appendectomy (removal of a normal appendix) rates were determined by the final pathologic report. Statistical comparison were made using the χ2 test and significance was assigned at p < 0.05. Five hundred four appendectomies were performed. Mean age was 10.1 ± 3.21 years, and 62.7% were boys. Overall, 308 children (61.1%) underwent CT scanning, 100 (19.8%) had US performed, and 97 (19.2%) had no radiographic study. A pathologically normal appendix was removed in 8.7% (27 of 308) of CT patients, 9.0% (9 of 100) of US patients, and 11.3% (11 of 97) of patients without a study. The frequency of CT scanning increased from 29.7% (27 of 91) of all children in 2007 to 75.6% (59 of 78) in 2012, whereas utilization of US decreased from 30.8% (28 of 91) to 11.5% (9 of 78). During this time period the difference in the negative appendectomy rate did change significantly from 14% to 6%. Liberal use of CT scans in diagnosing appendicitis in children has resulted in a decreased negative appendectomy rate.

Keywords: Appendicitis, CT scan, Ultrasound scan, Appendectomy, Negative

Figures and Tables

Fig. 1
Percentage of Patients with preoperative CT scan, and US by year.
jkaps-19-57-g001
Fig. 2
Percentage of patients with peforated appendicitis, nonperforated appendicitis, or negative appendectomy over the 6-year period.
jkaps-19-57-g002
Table 1
Patient Population Separated by Age Group
jkaps-19-57-i001
Table 2
Diagnostic Accuracy of Radiographic Studies
jkaps-19-57-i002

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