Use of CT scan in the diagnosis of pediatric acute appendicitis

Background: The efficacy of CT scan in the diagnosis of pediatric appendici tis has hot been established. Methods: Every patient under the age of 18 who was diagnosed and treated fo r acute appendicitis in the 1 year period front March 1998-March 1999 at La keland Regional Medical Center were included. The presentation, laboratory evaluation, imaging evaluation, hospital course, and pathologic evaluation were reviewed. Selected imaging studies were reviewed by an independent rad iologist. Results: Forty-six: patients mere treated for appendicitis; 17 of them rece ived CT scans (37%), The CT scans predicted appendicitis in 9 of 17 cases ( sensitivity = 53%). False-negative studies resulted in some morbidity but n o mortality. The radiology review indicated that three cases clearly did no t demonstrate appendicitis, The other false-negative studies were secondary to either technical or professional factors. Conclusion: The efficacy of CT imaging in the diagnosis of acute appendicit is in children has still not been demonstrated. This limited series indicat es that if CT scanning is to be used in pediatric patients, more attention to technical and professional factors may be required. Some of these factor s, particularly the ingestion of oral contrast, are particularly problemati c in small children and may limit the effectiveness of this modality.