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Diagnostic sensitivity of ultrasonography in pediatric appendicitis cases

Year 2022, Volume: 13 Issue: 47, 349 - 353, 15.12.2022

İnan Korkmaz Ayça Seyfettin Mehmet Çelikkaya

https://doi.org/10.17944/mkutfd.1057560

Abstract

Objective: In this study, it was aimed to investigate the sensitivity of ultrasonography in the diagnosis of appendicitis in the pediatric age group.

Method: 87 pediatric cases who were diagnosed with appendicitis after the operation, had preoperative USG examination and had no additional pathology causing acute abdomen were included in the study. The sensitivity of USG in the diagnosis of appendicitis was investigated by examining the USG reports of the cases retrospectively. In addition, the leukocyte counts, neutrophil ratios and CRP values of the cases were analyzed from the hospital archive and CT examinations, if any, from the PACS system.

Results: 71% of the cases were acute appendicitis, 29% of them were perforated appendicitis. USG was compatible with appendicitis in 74% of the cases, and the diagnostic sensitivity of USG was 74%. Secondary appendicitis findings were observed on USG in 16% of the cases, while USG was completely normal in 10% of the cases. Of the 26% cases that could not be diagnosed by USG, 10% of the cases were diagnosed by CT. The diagnosis was made by clinical findings in 16% of the cases. There was leukocytosis in 62% of the cases, an increase in the neutrophil ratio (shift to the left) in 84%, and elevated CRP in 86%, and at least one of these parameters was high in all cases.

Conclusion: Although ultrasonography is not sufficient to diagnose in all cases, the high sensitivity rate achieved in this study supports the knowledge that ultrasonography can be used as a first-choice diagnostic tool in pediatric patients with suspected acute appendicitis

Keywords

Appendicitis Ultrasonography Pediatric

References

  • Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015;386(10000):1278-87. https://doi.org/10.1016/S0140-6736(15)00275-5.
  • Nah SA, Ong SS, Lim WX, Amuddhu SK, Tang PH, Low Y. Clinical Relevance of the Nonvisualized Appendix on Ultrasonography of the Abdomen in Children. The Journal of Pediatrics. 2017;182(3):164-9. https://doi.org/10.1016/j.jpeds.2016.11.062.
  • Sømme S, Bronsert M, Morrato E, Ziegler M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics. 2013;132(6):1466-72. https://doi.org/10.1542/peds.2013-1243.
  • Applegate KE, Sivit CJ, Salvator AE, Borisa VJ, Dudgeon DL, Stallion AE, et al. Effect of Cross-sectional Imaging on Negative Appendectomy and Perforation Rates in Children. Radiology. 2001;220(1):103-7. https://doi.org/10.1148/radiology.220.1.r01jl17103.
  • Tseng P, Berdahl C, Kearl YL, Behar S, Cooper J, Dollbaum R, et al. Does Right Lower Quadrant Abdominal Ultrasound Accurately Identify Perforation in Pediatric Acute Appendicitis? Journal of Emergency Medicine. 2016;50(4):638-42. https://doi.org/10.1016/j.jemermed.2015.10.007.
  • Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990;132(5):910-25. https://doi.org/10.1093/oxfordjournals.aje.a115734.
  • Pogorelić Z, Rak S, Mrklić I, Jurić I. Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. Pediatric emergency care. 2015;31(3):164-8. https://doi.org/10.1097/PEC.0000000000000375.
  • Chung PHY, Dai K, Yang Z, Wong KKY. Validity of Alvarado Score in predicting disease severity and postoperative complication in pediatric acute appendicitis. World Journal of Pediatric Surgery. 2019;2(1): 3. https://doi.org/10.1136/wjps-2018-000003.
  • Samuel M. Pediatric appendicitis score. Journal of Pediatric Surgery. 2002;37(6):877-81. https://doi.org/10.1053/jpsu.2002.32893.
  • Nah SA, Ong SS, Lim WX, Amuddhu SK, Tang PH, Low Y. Clinical Relevance of the Nonvisualized Appendix on Ultrasonography of the Abdomen in Children. J Pediatr. 2017;182(3):164-9. https://doi.org/10.1016/j.jpeds.2016.11.062.
  • Sivit CJ, Siegel MJ, Applegate KE, Newman KD. When Appendicitis Is Suspected in Children. Radiographics : a review publication of the Radiological Society of North America, Inc. 2001;21(1):247-62. https://doi.org/10.1148/radiographics.21.1.g01ja17247.
  • Howell EC, Dubina ED, Lee SL. Perforation risk in pediatric appendicitis: assessment and management. Pediatric Health Med Ther. 2018;9(10):135-45. https://doi.org/10.2147/PHMT.S155302.
  • Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, et al. US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology. 2006;241(1):83-94. https://doi.org/10.1148/radiol.2411050913.
  • Peña BMG, Mandl KD, Kraus SJ, Fischer AC, Fleisher GR, Lund DP, et al. Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children. JAMA. 1999;282(11):1041-6. https://doi.org/10.1001/jama.282.11.1041.
  • Lowe LH, Penney MW, Stein SM, Heller RM, Neblett WW, Shyr Y, et al. Unenhanced Limited CT of the Abdomen in the Diagnosis of Appendicitis in Children. American Journal of Roentgenology. 2001;176(1):31-5. https://doi.org/10.2214/ajr.176.1.1760031.
  • Mittal MK, Dayan PS, Macias CG, Bachur RG, Bennett J, Dudley NC, et al. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. 2013;20(7):697-702. https://doi.org/10.1111/acem.12161.
  • Goldin AB, Khanna P, Thapa M, McBroom JA, Garrison MM, Parisi MT. Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy. Pediatric radiology. 2011;41(8):993-9. https://doi.org/10.1007/s00247-011-2018-2.
  • Zouari M, Jallouli M, Louati H, Kchaou R, Chtourou R, Kotti A, et al. Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort. The American Journal of Emergency Medicine. 2016;34(2):189-92. https://doi.org/10.1016/j.ajem.2015.10.004.
  • Bachur RG, Callahan MJ, Monuteaux MC, Rangel SJ. Integration of ultrasound findings and a clinical score in the diagnostic evaluation of pediatric appendicitis. J Pediatr. 2015;166(5):1134-9. https://doi.org/10.1016/j. jpeds.2015.01.034.
  • Sola R, Jr., Theut SB, Sinclair KA, Rivard DC, Johnson KM, Zhu H, et al. Standardized reporting of appendicitis-related findings improves reliability of ultrasound in diagnosing appendicitis in children. J Pediatr Surg. 2018;53(5):984-7. https://doi.org/10.1016/j.jpedsurg.2018.02.028.
  • Goske MJ, Applegate KE, Boylan J, Butler PF, Callahan MJ, Coley BD, et al. The ‘Image Gently’ campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatric radiology. 2008;38(3):265-9. https://doi.org/10.1007/s00247-007-0743-3.
  • Koberlein GC, Trout AT, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria(®) Suspected Appendicitis-Child. Journal of the American College of Radiology : JACR. 2019;16(5): 252-63. https://doi.org/10.1016/j.jacr.2019.02.022.
  • Prasetya D, Rochadi, Gunadi. Accuracy of neutrophil lymphocyte ratio for diagnosis of acute appendicitis in children: A diagnostic study. Ann Med Surg (Lond). 2019;48(10):35-8. https://doi.org/10.1016/j.amsu.2019.10.013.
  • Wang LT, Prentiss KA, Simon JZ, Doody DP, Ryan DP. The use of white blood cell count and left shift in the diagnosis of appendicitis in children. Pediatric emergency care. 2007;23(2):69-76. https://doi.org/10.1097/ PEC.0b013e31802d1716.

Pediatrik apandisit olgularında ultrasonografinin tanısal duyarlılığı

Year 2022, Volume: 13 Issue: 47, 349 - 353, 15.12.2022

İnan Korkmaz Ayça Seyfettin Mehmet Çelikkaya

https://doi.org/10.17944/mkutfd.1057560

Abstract

Amaç: Bu çalışmada pediatrik yaş grubunda ultrasonografinin apandisit tanısındaki duyarlılığının araştırılması amaçlanmıştır.

Yöntem: Operasyon sonucu apandisit tanısı alan, preoperatif USG tetkiki gerçekleştirilmiş olan ve akut batın sebebi olabilecek ek patolojisi bulunmayan 87 pediatrik olgu çalışmaya dahil edildi. Olguların USG raporları retrospektif olarak incelenerek USG’ nin apandisit tanısındaki duyarlılığı araştırıldı. Ayrıca olguların lökosit sayıları, nötrofil oranları ve CRP değerleri hastane arşivinden ve varsa BT tetkikleri PACS sisteminden incelendi.

Bulgular: Olguların % 71’i akut apandisit, %29’u perfore apandisitti. Olguların %74’ünün USG’si apandisit ile uyumlu olup USG’nin tanı duyarlılığı %74’dü, %16 olguda USG’de sekonder apandisit bulguları izlenirken %10 olguda USG tetkiki tamamen normaldi. USG ile tanı konulamayan %26 olgudan %10’unun tanısı BT ile konulmuştu. %16 olguda tanıya klinik bulgularla gidilmişti. Olguların %62’sinde lökositoz, %84’ünde nötrofil oranında artış (sola kayma), %86’sında ise CRP yüksekliği bulunmaktaydı ve olguların tamamında bu parametrelerin en az biri yüksekti.

Sonuç: Ultrasonografi her durumda tanı koymak için yeterli olmasa da bu çalışmada ulaşılan yüksek duyarlılık oranı, ultrasonografinin akut apandisit şüphesi bulunan pediatrik hastalarda ilk seçenek tanı aracı olarak kullanılabileceği bilgisini desteklemektedir.

Keywords

Apandisit Ultrasonografi Pediatrik

References

  • Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015;386(10000):1278-87. https://doi.org/10.1016/S0140-6736(15)00275-5.
  • Nah SA, Ong SS, Lim WX, Amuddhu SK, Tang PH, Low Y. Clinical Relevance of the Nonvisualized Appendix on Ultrasonography of the Abdomen in Children. The Journal of Pediatrics. 2017;182(3):164-9. https://doi.org/10.1016/j.jpeds.2016.11.062.
  • Sømme S, Bronsert M, Morrato E, Ziegler M. Frequency and variety of inpatient pediatric surgical procedures in the United States. Pediatrics. 2013;132(6):1466-72. https://doi.org/10.1542/peds.2013-1243.
  • Applegate KE, Sivit CJ, Salvator AE, Borisa VJ, Dudgeon DL, Stallion AE, et al. Effect of Cross-sectional Imaging on Negative Appendectomy and Perforation Rates in Children. Radiology. 2001;220(1):103-7. https://doi.org/10.1148/radiology.220.1.r01jl17103.
  • Tseng P, Berdahl C, Kearl YL, Behar S, Cooper J, Dollbaum R, et al. Does Right Lower Quadrant Abdominal Ultrasound Accurately Identify Perforation in Pediatric Acute Appendicitis? Journal of Emergency Medicine. 2016;50(4):638-42. https://doi.org/10.1016/j.jemermed.2015.10.007.
  • Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American journal of epidemiology. 1990;132(5):910-25. https://doi.org/10.1093/oxfordjournals.aje.a115734.
  • Pogorelić Z, Rak S, Mrklić I, Jurić I. Prospective validation of Alvarado score and Pediatric Appendicitis Score for the diagnosis of acute appendicitis in children. Pediatric emergency care. 2015;31(3):164-8. https://doi.org/10.1097/PEC.0000000000000375.
  • Chung PHY, Dai K, Yang Z, Wong KKY. Validity of Alvarado Score in predicting disease severity and postoperative complication in pediatric acute appendicitis. World Journal of Pediatric Surgery. 2019;2(1): 3. https://doi.org/10.1136/wjps-2018-000003.
  • Samuel M. Pediatric appendicitis score. Journal of Pediatric Surgery. 2002;37(6):877-81. https://doi.org/10.1053/jpsu.2002.32893.
  • Nah SA, Ong SS, Lim WX, Amuddhu SK, Tang PH, Low Y. Clinical Relevance of the Nonvisualized Appendix on Ultrasonography of the Abdomen in Children. J Pediatr. 2017;182(3):164-9. https://doi.org/10.1016/j.jpeds.2016.11.062.
  • Sivit CJ, Siegel MJ, Applegate KE, Newman KD. When Appendicitis Is Suspected in Children. Radiographics : a review publication of the Radiological Society of North America, Inc. 2001;21(1):247-62. https://doi.org/10.1148/radiographics.21.1.g01ja17247.
  • Howell EC, Dubina ED, Lee SL. Perforation risk in pediatric appendicitis: assessment and management. Pediatric Health Med Ther. 2018;9(10):135-45. https://doi.org/10.2147/PHMT.S155302.
  • Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, et al. US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology. 2006;241(1):83-94. https://doi.org/10.1148/radiol.2411050913.
  • Peña BMG, Mandl KD, Kraus SJ, Fischer AC, Fleisher GR, Lund DP, et al. Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children. JAMA. 1999;282(11):1041-6. https://doi.org/10.1001/jama.282.11.1041.
  • Lowe LH, Penney MW, Stein SM, Heller RM, Neblett WW, Shyr Y, et al. Unenhanced Limited CT of the Abdomen in the Diagnosis of Appendicitis in Children. American Journal of Roentgenology. 2001;176(1):31-5. https://doi.org/10.2214/ajr.176.1.1760031.
  • Mittal MK, Dayan PS, Macias CG, Bachur RG, Bennett J, Dudley NC, et al. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. 2013;20(7):697-702. https://doi.org/10.1111/acem.12161.
  • Goldin AB, Khanna P, Thapa M, McBroom JA, Garrison MM, Parisi MT. Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy. Pediatric radiology. 2011;41(8):993-9. https://doi.org/10.1007/s00247-011-2018-2.
  • Zouari M, Jallouli M, Louati H, Kchaou R, Chtourou R, Kotti A, et al. Predictive value of C-reactive protein, ultrasound and Alvarado score in acute appendicitis: a prospective pediatric cohort. The American Journal of Emergency Medicine. 2016;34(2):189-92. https://doi.org/10.1016/j.ajem.2015.10.004.
  • Bachur RG, Callahan MJ, Monuteaux MC, Rangel SJ. Integration of ultrasound findings and a clinical score in the diagnostic evaluation of pediatric appendicitis. J Pediatr. 2015;166(5):1134-9. https://doi.org/10.1016/j. jpeds.2015.01.034.
  • Sola R, Jr., Theut SB, Sinclair KA, Rivard DC, Johnson KM, Zhu H, et al. Standardized reporting of appendicitis-related findings improves reliability of ultrasound in diagnosing appendicitis in children. J Pediatr Surg. 2018;53(5):984-7. https://doi.org/10.1016/j.jpedsurg.2018.02.028.
  • Goske MJ, Applegate KE, Boylan J, Butler PF, Callahan MJ, Coley BD, et al. The ‘Image Gently’ campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatric radiology. 2008;38(3):265-9. https://doi.org/10.1007/s00247-007-0743-3.
  • Koberlein GC, Trout AT, Rigsby CK, Iyer RS, Alazraki AL, Anupindi SA, et al. ACR Appropriateness Criteria(®) Suspected Appendicitis-Child. Journal of the American College of Radiology : JACR. 2019;16(5): 252-63. https://doi.org/10.1016/j.jacr.2019.02.022.
  • Prasetya D, Rochadi, Gunadi. Accuracy of neutrophil lymphocyte ratio for diagnosis of acute appendicitis in children: A diagnostic study. Ann Med Surg (Lond). 2019;48(10):35-8. https://doi.org/10.1016/j.amsu.2019.10.013.
  • Wang LT, Prentiss KA, Simon JZ, Doody DP, Ryan DP. The use of white blood cell count and left shift in the diagnosis of appendicitis in children. Pediatric emergency care. 2007;23(2):69-76. https://doi.org/10.1097/ PEC.0b013e31802d1716.
There are 24 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Articles
Authors

İnan Korkmaz 0000-0001-6820-8199

Ayça Seyfettin 0000-0002-8540-9432

Mehmet Çelikkaya 0000-0003-3324-4960

Publication Date December 15, 2022
Submission Date January 13, 2022
Acceptance Date July 6, 2022
Published in Issue Year 2022 Volume: 13 Issue: 47

Cite

Vancouver Korkmaz İ, Seyfettin A, Çelikkaya M. Pediatrik apandisit olgularında ultrasonografinin tanısal duyarlılığı. mkutfd. 2022;13(47):349-53.
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