Abstract
Background
Some surgeons use nonoperative management with or without interval appendectomy for
patients who present with perforated appendicitis. These strategies depend on accurately
delineating perforation by computed tomography (CT). Since 2005, our institution has
used an evidence-based definition for perforation as a hole in the appendix or fecalith
in the abdomen. This has been shown to clearly separate those with a high risk of
abscess from those without. To quantify the ability of CT to identify which patients
would meet these criteria for perforation, we tested 6 surgeons and 2 radiologists
who evaluated blinded CT scans.
Methods
A junior and senior surgical residents, 2 staff interventional radiologists, and 4
attending pediatric surgeons with 3 to 30 years of experience reviewed 200 CT scans
of pediatric patients who had undergone a laparoscopic appendectomy. All CT scans
were reviewed electronically, and the reviewers were blinded to the results, outcome,
and intraoperative findings. None of the patients had a well-formed abscess on CT.
The reviewers were asked to decide only on perforated or nonperforated appendicitis
according to our intraoperative definition. Clinical admission data were reviewed
and compared between groups.
Results
In total, the reviewers were correct 72% of the time with an overall sensitivity of
62% and a specificity of 81%. The overall positive predictive value was 67%, and the
negative predictive value was 77%.
Conclusions
This study shows that in the absence of a well-formed abscess, the triage of patient
care based on a preoperative diagnosis of perforation from CT may be imprudent and
subject a portion of the population to an unnecessarily prolonged course of care.
Key words
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Article info
Publication history
Accepted:
October 6,
2009
Received:
October 5,
2009
Footnotes
Presented at the 40th Annual Meeting of the American Pediatric Surgical Association, Fajardo, Puerto Rico, May 28-June 1, 2009.
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
