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

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


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.

Figures and Tables

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


1. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132:910–925.
2. Rothrock SG, Skeoch G, Rush JJ, Johnson NE. Clinical features of misdiagnosed appendicitis in children. Ann Emerg Med. 1991; 20:45–50.
3. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology. 2000; 215:337–348.
4. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998; 338:141–146.
5. Peck J, Peck A, Peck C, Peck J. The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis. Am J Surg. 2000; 180:133–136.
6. Martin AE, Vollman D, Adler B, Caniano DA. CT scan may not reduce the negative appendectomy rate in children. J Pediatr Surg. 2004; 39(6):886–890.
7. Partrick DA, Janik JE, Janik JS, Bensard DD, Karrer FM. Increased CT scan utilization does not improve the diagnostic accuracy of appendicitis in children. J Pediatr Surg. 2003; 38(5):659–662.
8. Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001; 176:289–296.
9. Flum DR, Morris A, Koepsell T, Dellinger EP. Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA. 2001; 286:1748–1753.
10. Gore RM, Levine MS. Chapter 60, Disease of appendix. In : Balthaszar EJ, editor. Text book of Gastrointestinal Radiology. Philadelphia, PA: WB Sounders;2000. p. 1123–1156.
11. Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI. Evaluation of the Alvarado score in acute appendicitis. J R Soc Med. 1992; 85(2):87–88.
12. Jaremko JL, Crockett A, Rucker D, Magnus KG. Incidence and significance of inconclusive results in ultrasound for appendicitis in children and teenagers. Can Assoc Radiol J. 2011; 62(3):197–202.
13. Dillman JR, Strouse PJ, Ellis JH, Cohan RH, Jan SC. Incidence and severity of acute allergic-like reaction to IV nonionic iodinated contrast material in children. AJR Am J Roentgenol. 2007; 188:1643–1647.
14. Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, Cornwell EE 3rd, Chang DC, Siram SM. Negative appendectomy: a 10-year review of nationally representative sample. Am J Surg. 2011; 201:433–437.
15. McDonald GP, Pendarvis DP, Wilmonth R, Daley BJ. Influence of preoperative computed tomography on patients undergoing appendectomy. Am Surg. 2001; 67:1017–1021.
16. Old JL, Dusing RW, Yap W, Dirks J. Imaging for Suspected Appendicitis. Am Fam Physician. 2005; 71:71–78.
17. Karakas SP, Guelfguat M, Leonidas JC, Springer S, Singh SP. Acute appendicitis in children: Comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol. 2000; 30:94–98.
18. Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, Lee HS, Ahn S, Kim T, Hwang SS, Song KJ, Kang SB, Kim DW, Park SH, Lee KH. Low-Dose Abdominal CT for Evaluating Suspected Appendicitis. N Engl J Med. 2012; 366:1596–1605.
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