USE OF CT SCAN IN THE DIAGNOSIS OF PEDIATRIC ACUTE APPENDICITIS.

Reich JD, et al. Pediatr Emerg Care 2000 Aug;16(4):241-3.

BACKGROUND: The efficacy of CT scan in the diagnosis of pediatric appendicitis has hot been established.

METHODS: Every patient under the age of 18 who was diagnosed and treated for acute appendicitis in the 1 year period from March 1998-March 1999 at Lakeland Regional Medical Center were included. The presentation, laboratory evaluation, imaging evaluation, hospital course, and pathologic evaluation were reviewed. Selected imaging studies were reviewed by an independent radiologist.

RESULTS: Forty-six patients were treated for appendicitis; 17 of them received CT scans (37%). The CT scans predicted appendicitis in 9 of 17 cases (sensitivity = 53%). False-negative studies resulted in some morbidity but no mortality. The radiology review indicated that three cases clearly did not demonstrate appendicitis. The other false-negative studies were secondary to either technical or professional factors.

CONCLUSION: The efficacy of CT imaging in the diagnosis of acute appendicitis in children has still not been demonstrated. This limited series indicates that if CT scanning is to be used in pediatric patients, more attention to technical and professional factors may be required. Some of these factors, particularly the ingestion of oral contrast, are particularly problematic in small children and may limit the effectiveness of this modality.

COMMENTS: The use of CT in the evaluation of appendicitis in the pediatric population may be good in tertiary academic care centers where experienced pediatric radiologists are available. However, in the community setting, the true effectiveness may be much less. Therefore, a negative CT in a patient with high pretest suspicion does not rule out the possibility of an acute appendicitis.