Accuracy of ultrasonography for differentiating between simple and complex appendicitis in children

David J Nijssen,Laurens D Eeftinck Schattenkerk,Joost Van Schuppen,Roel Bakx,Paul Van Amstel,Ramon R Gorter

doi:10.1007/s00383-021-04872-8

Abstract

PurposeAccurate differentiation between simple and complex appendicitis is important since differences in treatment exist. This study aimed to assess the accuracy of ultrasonography in differentiating between simple and complex appendicitis.MethodsData from children aged < 18 years who underwent appendectomy between the 1st of January 2013 and the 1st of January 2018 were analyzed retrospectively. Ultrasonography reports of eligible children were divided into simple (test negative) and complex appendicitis (test positive) based on predefined criteria and compared to a gold standard (a combination of predefined perioperative and histopathological criteria). Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated to measure ultrasonographic accuracy in differentiating between simple and complex appendicitis.Results176 children were eligible for inclusion. The mean age at the time of operation was 10.1 ± SD 4.6 years. 84 (47.7%) children had simple appendicitis and 92 (52.3%) had complex appendicitis. The use of ultrasonography yielded a sensitivity: 46%, specificity: 90%, PPV: 84%, and NPV: 60%.ConclusionUltrasonography as standalone modality is not suitable for differentiating between simple and complex appendicitis in children. To improve preoperative differentiation, other variables such as clinical signs and laboratory data are necessary in conjunction with ultrasonography findings.

Highlights

Changing insights into the pathogenesis of acute appendicitis have led to the distinction of two types of appendicitis, simple and complex
We aimed to evaluate the accuracy of ultrasonography for differentiating between simple and complex appendicitis in children
The diagnosis of complex appendicitis on ultrasonography was associated with a high probability of finding complex appendicitis by the gold standard test

Summary

Introduction

Changing insights into the pathogenesis of acute appendicitis have led to the distinction of two types of appendicitis, simple and complex. In the last few years, more and more studies reported their outcome of a non-operative treatment strategy for patients with simple appendicitis. Overall, these studies show that a non-operative treatment strategy is safe and able to avoid an appendectomy in ± 75% of the children at 1-year follow-up [1,2,3]. Studies have shown that primary failure of the non-operative treatment strategy is partly due to misdiagnosis of complex appendicitis [1, 5]. Selection of eligible patients (i.e. patients with simple appendicitis) for a non-operative treatment strategy is crucial to further increase its effectiveness. In the diagnostic workup of children with suspected acute appendicitis, attention should be given to the assumed type of appendicitis

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Conclusion