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Effect of Cross-sectional Imaging on Negative Appendectomy and Perforation Rates in Children¹

¹ From the Departments of Radiology (K.E.A., C.J.S., V.J.B.), Pediatrics (A. E. Salvator), and Surgery (D.L.D., A. E. Stallion, E.R.G.), Rainbow Babies and Children’s Hospital of the University Hospitals of Cleveland and Case Western Reserve University School of Medicine, 11100 Euclid Ave, Cleveland, OH 44106-5056. Received September 28, 2000; revision requested November 4; revision received January 2, 2001; accepted February 6. K.E.A. was supported in part by the American Roentgen Ray Society Scholar Award. Address correspondence to K.E.A. (e-mail: applegate@uhrad.com).

PURPOSE: To compare negative appendectomy and perforation rates in children who underwent ultrasonography (US), computed tomography (CT), or no imaging before urgent appendectomy.

MATERIALS AND METHODS: All children who underwent urgent appendectomy during a 4-year period were identified in a surgical billing database. Pathology reports were coded as negative or as showing acute inflammation or perforation. Imaging up to 14 days before appendectomy or abscess drainage was noted, and imaging-based diagnoses were compared with pathologic findings. Patient age and sex were recorded.

RESULTS: Two hundred ninety-nine children, 176 (59%) male and 123 (41%) female (mean age, 10.4 years; age range, 1–21 years), underwent urgent appendectomy. One hundred twenty-six (42%) underwent no imaging, 121 (41%) underwent US with or without CT, and 52 (17%) underwent CT only; 44 (15%) underwent both US and CT. There were significantly higher rates of appendectomy with normal pathologic findings ("negative appendectomy") in patients who underwent no imaging (14% [18 of 126]) or US (17% [20 of 121]) versus the rates in those who underwent CT only (2% [one of 52]) (P = .02 and P = .007, respectively). The negative appendectomy rate was 7% in 96 patients who underwent CT with or without prior US. The perforation rates were not significantly different.

CONCLUSION: As compared with children who underwent no preoperative imaging and those who underwent US, children who underwent CT had a significantly lower negative appendectomy rate, without a significantly higher perforation rate.

Index terms: Appendicitis, 751.291 • Appendix, CT, 751.1211, 751.12112 • Appendix, US, 751.1298 • Computed tomography (CT), in infants and children, 751.12111, 751.12112 • Ultrasound (US), in infants and children, 751.1298

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