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US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis¹

¹ From the Departments of Diagnostic Imaging (A.S.D., C.J.K., M.E., P.S.B.), Population Health Sciences (J.B.), and Paediatrics (S.S., P.T.D.), the Hospital for Sick Children; Department of Public Health, Family and Community Medicine (R.M.), and Department of Health Policy Management and Evaluation (P.T.D.), Faculty of Medicine, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8. Received June 1, 2005; revision requested July 21; revision received September 22; accepted October 18; final version accepted January 2, 2006. A.S.D. supported in part by a RESTRACOMP award from the Research Institute, the Hospital for Sick Children, Toronto, Ontario, Canada. Address correspondence to A.S.D. (e-mail: andrea.doria{at}sickkids.ca).

Purpose: To perform a meta-analysis to evaluate the diagnostic performance of ultrasonography (US) and computed tomography (CT) for the diagnosis of appendicitis in pediatric and adult populations.

Materials and Methods: Medical literature (from 1986 to 2004) was searched for articles on studies that used US, CT, or both as diagnostic tests for appendicitis in children (26 studies, 9356 patients) or adults (31 studies, 4341 patients). Prospective and retrospective studies were included if they separately reported the rate of true-positive, true-negative, false-positive, and false-negative diagnoses of appendicitis from US and CT findings compared with the positive and negative rates of appendicitis at surgery or follow-up. Clinical variables, technical factors, and test performance were extracted. Three readers assessed the quality of studies.

Results: Pooled sensitivity and specificity for diagnosis of appendicitis in children were 88% (95% confidence interval [CI]: 86%, 90%) and 94% (95% CI: 92%, 95%), respectively, for US studies and 94% (95% CI: 92%, 97%) and 95% (95% CI: 94%, 97%), respectively, for CT studies. Pooled sensitivity and specificity for diagnosis in adults were 83% (95% CI: 78%, 87%) and 93% (95% CI: 90%, 96%), respectively, for US studies and 94% (95% CI: 92%, 95%) and 94% (95% CI: 94%, 96%), respectively, for CT studies.

Conclusion: From the diagnostic performance perspective, CT had a significantly higher sensitivity than did US in studies of children and adults; from the safety perspective, however, one should consider the radiation associated with CT, especially in children.

Supplemental material: radiology.rsnajnls.org/cgi/content/full/2411050913/DC1

© RSNA, 2006

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