The Effect of Abdominal Pain Duration on the Accuracy of Diagnostic Imaging for Pediatric Appendicitis - 20/10/12
, Peter S. Dayan, MD, MSc b, Lalit Bajaj, MD c, Charles G. Macias, MD d, Manoj K. Mittal, MD e, Michelle D. Stevenson, MD f, Nanette C. Dudley, MD g, Kelly Sinclair, MD h, Jonathan Bennett, MD i, Michael C. Monuteaux, ScD a, Anupam B. Kharbanda, MD, MSc b, jPediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics
Address for correspondence: Richard G. Bachur, MDRésumé |
Study objective |
Advanced imaging with computed tomography (CT) or ultrasonography is frequently used to evaluate for appendicitis. The duration of the abdominal pain may be related to the stage of disease and therefore the interpretability of radiologic studies. Here, we investigate the influence of the duration of pain on the diagnostic accuracy of advanced imaging in children being evaluated for acute appendicitis.
Methods |
A secondary analysis of a prospective multicenter observational cohort of children aged 3 to 18 years with suspected appendicitis who underwent CT or ultrasonography was studied. Outcome was based on histopathology or telephone follow-up. Treating physicians recorded the duration of pain. Imaging was coded as positive, negative, or equivocal according to an attending radiologist's interpretation.
Results |
A total of 1,810 children were analyzed (49% boys, mean age 10.9 years [SD 3.8 years]); 1,216 (68%) were assessed by CT and 832 (46%) by ultrasonography (238 [13%] had both). The sensitivity of ultrasonography increased linearly with increasing pain duration (test for trend: odds ratio=1.39; 95% confidence interval 1.14 to 1.71). There was no association between the sensitivity of CT or specificity of either modality with pain duration. The proportion of equivocal CT readings significantly decreased with increasing pain duration (test for trend: odds ratio=0.76; 95% confidence interval 0.65 to 0.90).
Conclusion |
The sensitivity of ultrasonography for appendicitis improves with a longer duration of abdominal pain, whereas CT demonstrated high sensitivity regardless of pain duration. Additionally, CT results (but not ultrasonographic results) were less likely to be equivocal with longer duration of abdominal pain.
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| Supervising editors: David M. Jaffe, MD; Steven M. Green, MD |
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| Author contributions: ABK was the principal investigator for the original multicenter study proposal and was responsible for oversight over the parent study protocol, data collection, data security, and multicenter coordination. ABK approved the secondary analysis. PSD, LB, CGM, MKM, MDS, NCD, KS, JB, MCM, and AKB provided critical review of the article. PSD was the senior investigator for the original multicenter study. RGB and MCM were responsible for drafting the article. RGB conceived of this secondary study and was responsible for primary data analysis. LB, CGM, MKM, MDS, NCD, KS, and JB contributed as site principal investigators under the parent protocol. MCM provided statistical expertise. RGB takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. |
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| Publication date: Available online July 27, 2012. |
Vol 60 - N° 5
P. 582 - novembre 2012 Retour au numéro
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