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Suspected Appendicitis in Children: Rectal and Intravenous Contrast-enhanced versus Intravenous Contrast-enhanced CT¹

¹ From the Division of Emergency Medicine (A.B.K., R.G.B.) and Department of Radiology (G.A.T.), Children's Hospital Boston, Harvard Medical School, Boston, Mass. Received January 30, 2006; revision requested March 28; revision received April 21; accepted May 25; final version accepted September 5. Address correspondence to A.B.K., Division of Pediatric Emergency Medicine, Morgan Stanley Children's Hospital of New York, Columbia University, 622 W 168th St, New York, NY 10069 (e-mail: ak493{at}columbia.edu).

Purpose: To retrospectively compare the diagnostic performance of intravenous contrast material–enhanced computed tomography (CT) with that of intravenous and rectal contrast-enhanced CT in the evaluation of children suspected of having appendicitis by using pathologic findings, surgical findings, or a follow-up telephone call as the reference standard.

Materials and Methods: This HIPAA-compliant study was approved by the committee on clinical investigations. As part of a larger study, informed consent was obtained from all parents and from all children older than 7 years. Consecutive patients aged 5–21 years who presented to the emergency department and were suspected of having appendicitis were studied with CT. From April 2003 until February 2004, patients underwent intravenous and rectal contrast-enhanced CT. From March 2004 until December 2004, patients underwent intravenous contrast-enhanced CT. Demographic data, clinical outcomes, and test performance characteristics—including sensitivity, specificity, accuracy, and negative and positive predictive values—were compared.

Results: Of the 416 patients who met inclusion criteria, 223 underwent intravenous and rectal contrast-enhanced CT and 193 underwent intravenous contrast-enhanced CT. There were no differences in sex distribution (55% vs 52% male patients), frequency of appendicitis (36% vs 32%), or frequency of equivocal CT findings (4%) between the groups. Intravenous and rectal contrast-enhanced CT had a sensitivity of 92% (95% confidence interval [CI]: 85%, 97%), a specificity of 87% (95% CI: 79%, 92%), a negative predictive value of 94% (95% CI: 90%, 98%), and an accuracy of 89% (95% CI: 85%, 93%). Intravenous contrast-enhanced CT had a sensitivity of 93% (95% CI: 84%, 97%), a specificity of 92% (95% CI: 85%, 96%), a negative predictive value of 95% (95% CI: 90%, 99%), and an accuracy of 92% (95% CI: 88%, 96%) (P > .2 for all comparisons).

Conclusion: There was no significant difference between the performance of intravenous contrast-enhanced CT and that of rectal and intravenous contrast-enhanced CT in children suspected of having appendicitis.

© RSNA, 2007