Fraukje Wiersma MD, Presenter: Nothing to Disclose

Boudewijn Toorenvliet MD, Abstract Co-Author: Nothing to Disclose

Jan Hein Allema MD, PhD, Abstract Co-Author: Nothing to Disclose

Herma C. Holscher MD, PhD, Abstract Co-Author: Nothing to Disclose

Evaluation of a new classification in diagnosing appendicitis with ultrasound in children.

From May 2005 to June 2006 212 consecutive pediatric patients with suspected appendicitis were examined with ultrasound. Depiction of appendix was classified in four groups; 1: normal appendix, 2: appendix not depicted, no secondary signs of appendicitis, 3: appendix not depicted with secondary signs of appendicitis (inflamed fat or fluid), 4: depiction of inflamed appendix. Patients of group 3 and 4 were treated surgically. Ultrasonographic diagnoses were correlated with histopathologic results or clinical follow-up. Negative appendectomy rate, perforation rate and predictive values of this classification were calculated. For statistical analysis, McNemar test was applied for comparison of predictive values of this classification with classification used in literature.

Group1: 95, group 2: 41, group 3: 9 and group 4: 67 patients. US classification was false positive in 4 patients and false negative in one. Prevalence of appendicitis was 34%. This classification had a sensitivity of 99%, specificity of 97%, positive predictive value of 93%, negative predictive value 99% and accuracy of 97%. Negative appendectomy rate was 5% and perforation rate, 16%. Sensitivity of this classification was significantly higher than the one used in previous studies (p=0.02). No statistical difference in specificity (p=0.05).

This classification of the ultrasonographic depiction of the appendix and surrounding area has high predictive values in children with suspected appendicitis and prevents a high rate of negative appendectomy and complications of unrecognized appendicitis.

This classification improves surgical decision making in diagnosing or excluding appendicitis in children.

Wiersma, F, Toorenvliet, B, Allema, J, Holscher, H, Ultrasonography of Suspected Appendicitis in Children: A New Ultrasonographic Classification.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5008493.html