Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients

Einat Blumfield, Gopi Nayak, Ramya Srinivasan, Matthew Tadashi Muranaka, Netta M. Blitman, Anthony Blumfield, Terry L. Levin

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

OBJECTIVE. Acute appendicitis is the most common condition requiring emergency surgery in children. Differentiation of perforated from nonperforated appendicitis is important because perforated appendicitis may initially be managed conservatively whereas nonperforated appendicitis requires immediate surgical intervention. CT has been proved effective in identifying appendiceal perforation. The purpose of this study was to determine whether perforated and nonperforated appendicitis in children can be similarly differentiated with ultrasound. MATERIALS AND METHODS. This retrospective study included 161 consecutively registered children from two centers who had acute appendicitis and had undergone ultrasound and appendectomy. Ultrasound images were reviewed for appendiceal size, appearance of the appendiceal wall, changes in periappendiceal fat, and presence of free fluid, abscess, or appendicolith. The surgical report served as the reference standard for determining whether perforation was present. The specificity and sensitivity of each ultrasound finding were determined, and binary models were generated. RESULTS. The patients included were 94 boys and 67 girls (age range, 1-20 years; mean, 11 ± 4.4 [SD] years) The appendiceal perforation rate was significantly higher in children younger than 8 years (62.5%) compared with older children (29.5%). Sonographic findings associated with perforation included abscess (sensitivity, 36.2%; specificity, 99%), loss of the echogenic submucosal layer of the appendix in a child younger than 8 years (sensitivity, 100%; specificity, 72.7%), and presence of an appendicolith in a child younger than 8 years (sensitivity, 68.4%; specificity, 91.7%). CONCLUSION. Ultrasound is effective for differentiation of perforated from nonperforated appendicitis in children.

Original languageEnglish (US)
Pages (from-to)957-962
Number of pages6
JournalAmerican Journal of Roentgenology
Volume200
Issue number5
DOIs
StatePublished - May 1 2013

Fingerprint

Appendicitis
Pediatrics
Abscess
Appendectomy
Emergencies
Retrospective Studies
Fats
Sensitivity and Specificity

Keywords

  • Pediatric
  • Perforated appendicitis
  • Ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients. / Blumfield, Einat; Nayak, Gopi; Srinivasan, Ramya; Muranaka, Matthew Tadashi; Blitman, Netta M.; Blumfield, Anthony; Levin, Terry L.

In: American Journal of Roentgenology, Vol. 200, No. 5, 01.05.2013, p. 957-962.

Research output: Contribution to journalArticle

Blumfield, Einat ; Nayak, Gopi ; Srinivasan, Ramya ; Muranaka, Matthew Tadashi ; Blitman, Netta M. ; Blumfield, Anthony ; Levin, Terry L. / Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients. In: American Journal of Roentgenology. 2013 ; Vol. 200, No. 5. pp. 957-962.
@article{f111c27da019473c9afae22f594aaa7e,
title = "Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients",
abstract = "OBJECTIVE. Acute appendicitis is the most common condition requiring emergency surgery in children. Differentiation of perforated from nonperforated appendicitis is important because perforated appendicitis may initially be managed conservatively whereas nonperforated appendicitis requires immediate surgical intervention. CT has been proved effective in identifying appendiceal perforation. The purpose of this study was to determine whether perforated and nonperforated appendicitis in children can be similarly differentiated with ultrasound. MATERIALS AND METHODS. This retrospective study included 161 consecutively registered children from two centers who had acute appendicitis and had undergone ultrasound and appendectomy. Ultrasound images were reviewed for appendiceal size, appearance of the appendiceal wall, changes in periappendiceal fat, and presence of free fluid, abscess, or appendicolith. The surgical report served as the reference standard for determining whether perforation was present. The specificity and sensitivity of each ultrasound finding were determined, and binary models were generated. RESULTS. The patients included were 94 boys and 67 girls (age range, 1-20 years; mean, 11 ± 4.4 [SD] years) The appendiceal perforation rate was significantly higher in children younger than 8 years (62.5{\%}) compared with older children (29.5{\%}). Sonographic findings associated with perforation included abscess (sensitivity, 36.2{\%}; specificity, 99{\%}), loss of the echogenic submucosal layer of the appendix in a child younger than 8 years (sensitivity, 100{\%}; specificity, 72.7{\%}), and presence of an appendicolith in a child younger than 8 years (sensitivity, 68.4{\%}; specificity, 91.7{\%}). CONCLUSION. Ultrasound is effective for differentiation of perforated from nonperforated appendicitis in children.",
keywords = "Pediatric, Perforated appendicitis, Ultrasound",
author = "Einat Blumfield and Gopi Nayak and Ramya Srinivasan and Muranaka, {Matthew Tadashi} and Blitman, {Netta M.} and Anthony Blumfield and Levin, {Terry L.}",
year = "2013",
month = "5",
day = "1",
doi = "10.2214/AJR.12.9801",
language = "English (US)",
volume = "200",
pages = "957--962",
journal = "American Journal of Roentgenology",
issn = "0361-803X",
publisher = "American Roentgen Ray Society",
number = "5",

}

TY - JOUR

T1 - Ultrasound for differentiation between perforated and nonperforated appendicitis in pediatric patients

AU - Blumfield, Einat

AU - Nayak, Gopi

AU - Srinivasan, Ramya

AU - Muranaka, Matthew Tadashi

AU - Blitman, Netta M.

AU - Blumfield, Anthony

AU - Levin, Terry L.

PY - 2013/5/1

Y1 - 2013/5/1

N2 - OBJECTIVE. Acute appendicitis is the most common condition requiring emergency surgery in children. Differentiation of perforated from nonperforated appendicitis is important because perforated appendicitis may initially be managed conservatively whereas nonperforated appendicitis requires immediate surgical intervention. CT has been proved effective in identifying appendiceal perforation. The purpose of this study was to determine whether perforated and nonperforated appendicitis in children can be similarly differentiated with ultrasound. MATERIALS AND METHODS. This retrospective study included 161 consecutively registered children from two centers who had acute appendicitis and had undergone ultrasound and appendectomy. Ultrasound images were reviewed for appendiceal size, appearance of the appendiceal wall, changes in periappendiceal fat, and presence of free fluid, abscess, or appendicolith. The surgical report served as the reference standard for determining whether perforation was present. The specificity and sensitivity of each ultrasound finding were determined, and binary models were generated. RESULTS. The patients included were 94 boys and 67 girls (age range, 1-20 years; mean, 11 ± 4.4 [SD] years) The appendiceal perforation rate was significantly higher in children younger than 8 years (62.5%) compared with older children (29.5%). Sonographic findings associated with perforation included abscess (sensitivity, 36.2%; specificity, 99%), loss of the echogenic submucosal layer of the appendix in a child younger than 8 years (sensitivity, 100%; specificity, 72.7%), and presence of an appendicolith in a child younger than 8 years (sensitivity, 68.4%; specificity, 91.7%). CONCLUSION. Ultrasound is effective for differentiation of perforated from nonperforated appendicitis in children.

AB - OBJECTIVE. Acute appendicitis is the most common condition requiring emergency surgery in children. Differentiation of perforated from nonperforated appendicitis is important because perforated appendicitis may initially be managed conservatively whereas nonperforated appendicitis requires immediate surgical intervention. CT has been proved effective in identifying appendiceal perforation. The purpose of this study was to determine whether perforated and nonperforated appendicitis in children can be similarly differentiated with ultrasound. MATERIALS AND METHODS. This retrospective study included 161 consecutively registered children from two centers who had acute appendicitis and had undergone ultrasound and appendectomy. Ultrasound images were reviewed for appendiceal size, appearance of the appendiceal wall, changes in periappendiceal fat, and presence of free fluid, abscess, or appendicolith. The surgical report served as the reference standard for determining whether perforation was present. The specificity and sensitivity of each ultrasound finding were determined, and binary models were generated. RESULTS. The patients included were 94 boys and 67 girls (age range, 1-20 years; mean, 11 ± 4.4 [SD] years) The appendiceal perforation rate was significantly higher in children younger than 8 years (62.5%) compared with older children (29.5%). Sonographic findings associated with perforation included abscess (sensitivity, 36.2%; specificity, 99%), loss of the echogenic submucosal layer of the appendix in a child younger than 8 years (sensitivity, 100%; specificity, 72.7%), and presence of an appendicolith in a child younger than 8 years (sensitivity, 68.4%; specificity, 91.7%). CONCLUSION. Ultrasound is effective for differentiation of perforated from nonperforated appendicitis in children.

KW - Pediatric

KW - Perforated appendicitis

KW - Ultrasound

UR - http://www.scopus.com/inward/record.url?scp=84879314955&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879314955&partnerID=8YFLogxK

U2 - 10.2214/AJR.12.9801

DO - 10.2214/AJR.12.9801

M3 - Article

VL - 200

SP - 957

EP - 962

JO - American Journal of Roentgenology

JF - American Journal of Roentgenology

SN - 0361-803X

IS - 5

ER -