Abstract
Acute appendicitis is the most common acute abdominal condition that requires surgical intervention in childhood. From the diagnostic performance perspective, computed tomography (CT) has a significantly higher sensitivity than does ultrasound (US) for diagnosing appendicitis in children; from the safety perspective, however, one should consider the radiation associated with CT, especially in children. There is strong evidence supporting improved patient outcomes in children with suspected acute appendicitis who undergo CT scanning. Nevertheless, we should keep in mind that for a single abdominal CT study in a 5-year-old child, the lifetime risk of radiation-induced cancer would be 26.1 per 100,000 in female and 20.4 per 100,000 in male patients, based on probabilistic models designed with data from atomic bomb survivors. An integrated clinical-imaging approach, applying clinical scores that are able to predict which children with acute abdominal pain do or do not have a high probability of presenting with appendicitis may improve the effectiveness of the imaging diagnosis of appendicitis at the hospital level. Such an approach could avoid exposure of children who at low risk for appendicitis to unnecessary diagnostic tests and eventually, to radiation.
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References
Blakely ML, Lally KP (2002) Using evidence-based medicine principles to improve quality of patient care in pediatric surgery. Semin Pediatr Surg 11:42–45
Guillerman RP, Brody AS, Kraus SJ (2002) Evidence-based guidelines for pediatric imaging: the example of the child with possible appendicitis. Pediatr Ann 31:629–640
Kainberger F, Czembirek H, Frühwald F et al (2002) Guidelines and algorithms: strategies for standardization of referral criteria in diagnostic radiology. Eur Radiol 12:673–679
Egger M, Smith GD, O’Rourke K (2001) Rationale, potentials, and promise of systematic reviews. In: Egger M, Smith GD, Altman DG (eds) Systematic reviews in health care. Meta-analysis in context. BMJ, London, pp 3–19
Doria AS (2005) Meta-analysis and structured literature review in radiology. Acad Radiol 12:399–408
Bachmann LM, Bischof DB, Bischofberger SA et al (2002) Systematic quantitative overviews of the literature to determine the value of diagnostic tests for predicting acute appendicitis: study protocol. BMC Surg 2:1–5
Henderson J, Goldacre MJ, Fairweather JM et al (1992) Conditions accounting for substantial time spent in hospital in children aged 1–14 years. Arch Dis Child 67:83–86
Siegel MJ (1992) Acute appendicitis in childhood: the role of US [comment]. Radiology 185:341–342
Puylaert JB, van der Zant FM, Rijke AM (1997) Sonography and the acute abdomen: practical considerations. AJR Am J Roentgenol 168:179–186
Sivit CJ (1997) Imaging children with acute right lower quadrant pain. Pediatr Clin North Am 44:575–589
Sivit CJ, Siegel MJ, Applegate KE et al (2001) When appendicitis is suspected in children. RadioGraphics 21:247–262
Malone AJ, Wolf CR, Malmed AS et al (1993) Diagnosis of acute appendicitis: value of unenhanced CT. AJR Am J Roentgenol 160:763–766
Frush DP, Donnelly LF (1998) Helical CT in children: technical considerations and body applications. Radiology 209:37–48
Orr RK, Porter D, Hartman D (1995) Ultrasonography to evaluate adults for appendicitis: decision making based on meta-analysis and probabilistic reasoning. Acad Emerg Med 2:644–650
Terasawa T, Blackmore CC, Bent S et al (2004) Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 141:537–546
Yu SH, Kim CB, Park JW et al (2005) Ultrasonography in the diagnosis of appendicitis: evaluation by meta-analysis. Korean J Radiol 6:267–277
Weston AR, Jackson TJ, Blamey S (2005) Diagnosis of appendicitis in adults by ultrasonography or computed tomography: a systematic review and meta-analysis. Int J Technol Assess Health Care 21:368–379
Al-Khayal KA, Al-Omran MA (2007) Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. A meta-analysis. Saudi Med J 28:173–180
van Randen A, Bipat S, Zwinderman AH et al (2008) Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 249:97–106
Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94
Brenner D, Elliston C, Hall E et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296
Pierce DA, Shimizu Y, Preston DL et al (1996) Studies of the mortality of atomic bomb survivors. Report 12, part I. Cancer: 1950–1990. Radiat Res 146:1–27
Wan MJ, Krahn M, Ungar W et al (2008) Cost-effectiveness of ultrasonography versus computed tomography in the diagnosis of acute appendicitis in children: a Markov decision analytic model. Radiology (in press)
Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32:228–223
Committee to assess health risks from exposure to low levels of ionizing radiation—National Research Council. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. Washington, DC: National Research Council, 2006
Levels of Evidence. Oxford Centre for Evidence-Based MedicineWeb Site. http://www.cebm.net/levels_of_evidence.asp. Accessed November 2008
Garcia Peña BM, Mandl KD, Kraus SJ et al (1999) Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA 282:1041–1046
Sivit CJ, Newman KD, Boenning DA et al (1992) Appendicitis: usefulness of US in diagnosis in a pediatric population. Radiology 185:549–552
Sivit CJ, Applegate KE (2003) Imaging of acute appendicitis in children. Semin Ultrasound CT MR 24:74–82
Rao PM, Rhea JT, Rattner DW et al (1999) Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 229:344–349
Applegate KE, Sivit CJ, Salvator AE et al (2001) Effect of cross-sectional imaging on negative appendectomy and perforation rates in children. Radiology 220:103–137
Hörmann M, Paya K, Eibenberger K et al (1998) MR imaging in children with nonperforated acute appendicitis: value of unenhanced MR imaging in sonographically selected cases. AJR Am J Roentgenol 171:467–470
Rypins EB, Kipper SL, Weiland F et al (2002) 99mTc anti-CD 15 monoclonal antibody (LeuTech) imaging improves diagnostic accuracy and clinical management in patients with equivocal presentation of appendicitis. Ann Surg 235:232–239
Kipper SL (1999) The role of radiolabeled leukocyte imaging in the management of patients with acute appendicitis. Q J Nucl Med 43:83–92
Doria AS, Amernic H, Dick P et al (2005) Cost-effectiveness analysis of weekday and weeknight-or-weekend shifts for assessment of appendicitis. Pediatr Radiol 35:1186–1195
Warner BW, Rich KA, Atherton H et al (2002) The sustained impact of an evidenced-based clinical pathway for acute appendicitis. Semin Pediatr Surg 11:29–35
Kharbanda AB, Taylor GA, Fishman SJ et al (2005) A clinical decision rule to identify children at low risk for appendicitis. Pediatrics 116:709–716
Goldman RD, Carter S, Stephens D et al (2008) Prospective validation of the pediatric appendicitis score. J Pediatr 153:278–282
Wan M, Doria AS (2006) First aid for the imaging of pediatric appendicitis. UWO Medical Journal 75(1):S2–S4
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Dr. Doria has indicated that she has no relevant financial relationships or potential conflicts or interest related to the material presented.
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Doria, A.S. Optimizing the role of imaging in appendicitis. Pediatr Radiol 39 (Suppl 2), 144–148 (2009). https://doi.org/10.1007/s00247-008-1105-5
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DOI: https://doi.org/10.1007/s00247-008-1105-5