Special x-ray detects appendicitis in children

A specialized x-ray of the abdomen may help diagnose appendicitis in children when initial tests come back negative or inconclusive, according to a report in the September 15th issue of The Journal of the American Medical Association.

In the study of 139 children and adolescents with symptoms of appendicitis, 108 participants underwent ultrasonography along with computed tomography with rectal contrast (CTRC) scans. Together, the two tests were 94% accurate for the diagnosis of appendicitis in children, report lead author Dr. Barbara M. Garcia Pena of Harvard Medical School in Boston, Massachusetts, and colleagues.

``The use of ultrasonography in the diagnosis of childhood appendicitis has increased steadily; however, ultrasonography is highly operator dependent'' and not consistently accurate at arriving at negative diagnoses, the researchers explain. While the CTRC scan is about 98% accurate in diagnosing adult appendicitis, this is the first study to evaluate the test in children.

There are 60,000 to 80,000 cases of appendicitis diagnosed among children annually in the US, making appendectomy the most common emergency abdominal surgery among American children. Appendicitis, an inflammation of the appendix, is marked by abdominal pain, fever, and vomiting.

To arrive at their findings, the researchers studied children and adolescents who presented to the emergency room of Children's Hospital in Boston with symptoms of appendicitis but in whom the diagnosis was uncertain. If an ultrasound test yielded positive results, the appendix was removed. If ultrasound results came back negative or inconclusive, the specialized CTRC scans were employed.

Ultrasound was able to identify a normal appendix in 2 out of 83 participants, whereas the CTRC scan was able to identify a normal appendix in 62 of 74 patients. The authors report that the use of both ultrasonography and the CTRC scan ``resulted in a beneficial change in patient management in 79 (73.1%) of the 108 children.'' By comparison, when used alone, ''ultrasonography resulted in a beneficial change in patient management in 26 (18.7%) of the 139 children,'' Garcia Pena and colleagues note.

Adding a CTRC scan to a negative ultrasound exam increased the accuracy of the test from 44% to 94%, the researchers report.

``These data show that CTRC following a negative or indeterminate ultrasonography result is highly accurate in the diagnosis of appendicitis in children,'' concludes the research team.

``We believe that CTRC should be reserved for those children in whom, after full clinical evaluation, the diagnosis remains uncertain,'' Garcia Pena and colleagues note. More research is needed before the scan can be recommended as the first line evaluation in subsets of children, they add.

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