Improving the diagnosis of acute appendicitis in children with atypical clinical findings using the technetium-99m hexamethylpropylene amine oxime-labelled white-blood-cell abdomen scan

BACKGROUND: Diagnosing acute appendicitis in children with equivocal signs and symptoms may be difficult. The usual approach is hospital observation and frequent re-examination. However, many surgeons are reluctant to delay surgery because of the risk of perforation and a negative laparotomy. OBJECTIVE: To assess and compare the value of the technetium-99m hexamethylpropylene amine oxime ((99m)Tc-HMPAO)-labelled white-blood-cell (WBC) abdomen scan in the diagnosis of acute appendicitis in children with atypical clinical presentation. PATIENTS AND METHODS: Fifty children with acute right lower quadrant abdominal pain and possible acute appendicitis, but atypical findings were included. After IV injection of (99m)Tc-HMPAO-labelled WBCs, serial anterior abdomen scans were obtained using a gamma camera. RESULTS: Thirty-three children underwent surgery, while 17 children were managed conservatively and were followed up for at least 1 month. Four children had false-positive results and one child had a false-negative scan result. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the scan to diagnose acute appendicitis in children with atypical findings was 96.7, 80.0, 90.0, 87.8 and 94.1%, respectively. CONCLUSIONS: The (99m)Tc-HMPAO WBC abdomen scan is a potential tool for diagnosing acute appendicitis in children with atypical clinical findings. The high sensitivity and negative predictive value allows early discharge from the emergency department to avoid costly observation in hospital and potentially unnecessary surgery in those patients with negative scans.     

Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis.

OBJECTIVES: To assess the accuracy of clinical examination as compared with ultrasound imaging in the diagnosis of infantile hypertrophic pyloric stenosis. Duration of hospital stay, time between admission and surgery, and financial implications were also considered. DESIGN: A prospective study of patients referred to the surgical team with a possible diagnosis of pyloric stenosis from May 1993 to January 1995. SETTING: Neonatal and paediatric surgical wards and imaging department of a paediatric teaching hospital. SUBJECTS: 116 patients referred to the surgical team with a possible diagnosis of pyloric stenosis. RESULTS: 75 patients in this study had pyloric stenosis (64.6%). Clinical examination had a sensitivity of 72%, specificity of 97%, with a positive and negative predictive value of 98% and 61% respectively. There were 16 diagnostic errors (one false positive and 15 false negative). Ultrasound imaging had a sensitivity of 97%, specificity of 100%, with a positive and negative predictive value of 100% and 98% respectively. There was one diagnostic error (one false negative). Eight patients required repeat scans for confirmation of the diagnosis. On review of the initial scans in these patients, seven were noted to have inaccurate measurements due to poor technique. The average time between repeated scans was 28.2 hours. Ultrasound imaging cost 13.90 pounds per scan and initiated a change in management only in the clinically false negative group at a cost of 52 pounds per patient. The average duration of hospital stay was 3.1 days and the mean time between admission and surgery was 19.2 hours. The total cost for treatment of a patient with pyloric stenosis was 1602 pounds. CONCLUSION: Ultrasound imaging should be reserved for those cases where clinical examination is negative and should be carried out by sonographers who see enough cases to maintain their expertise.     

Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis

OBJECTIVES: To assess the accuracy of clinical examination as compared with ultrasound imaging in the diagnosis of infantile hypertrophic pyloric stenosis. Duration of hospital stay, time between admission and surgery, and financial implications were also considered. DESIGN: A prospective study of patients referred to the surgical team with a possible diagnosis of pyloric stenosis from May 1993 to January 1995. SETTING: Neonatal and paediatric surgical wards and imaging department of a paediatric teaching hospital. SUBJECTS: 116 patients referred to the surgical team with a possible diagnosis of pyloric stenosis. RESULTS: 75 patients in this study had pyloric stenosis (64.6%). Clinical examination had a sensitivity of 72%, specificity of 97%, with a positive and negative predictive value of 98% and 61% respectively. There were 16 diagnostic errors (one false positive and 15 false negative). Ultrasound imaging had a sensitivity of 97%, specificity of 100%, with a positive and negative predictive value of 100% and 98% respectively. There was one diagnostic error (one false negative). Eight patients required repeat scans for confirmation of the diagnosis. On review of the initial scans in these patients, seven were noted to have inaccurate measurements due to poor technique. The average time between repeated scans was 28.2 hours. Ultrasound imaging cost 13.90 pounds per scan and initiated a change in management only in the clinically false negative group at a cost of 52 pounds per patient. The average duration of hospital stay was 3.1 days and the mean time between admission and surgery was 19.2 hours. The total cost for treatment of a patient with pyloric stenosis was 1602 pounds. CONCLUSION: Ultrasound imaging should be reserved for those cases where clinical examination is negative and should be carried out by sonographers who see enough cases to maintain their expertise.     

Acetylcholinesterase activity in rectal biopsies: an assessment of its diagnostic value in Hirschsprung's disease

Acetylcholinesterase (AChE) activity was measured in rectal suction biopsies from 392 patients investigated for Hirschsprung's disease (HD). Results in HD (2.7-23.7 RU; n = 37) were not clearly differentiated from those in patients without HD (0.6-18.0 RU; n = 355). Sample instability was shown not to be a significant cause of error. From analysis of duplicate biopsies and a consideration of false-negative results, tissue inhomogeneity or incorrect siting of the biopsy appeared likely causes of error. Examination of a number of possible diagnostic decision levels indicated an optimal choice of AChE activity greater than 10 RU with an AChE activity not less than 60% of total cholinesterase activity. At a prevalence of 10%, this decision level resulted in sensitivity of 64.9%, specificity 98.7%, predictive value of positive 85.7%, and predictive value of negative 96.3%. The false positives (n = 4) and false negatives (n = 13) by these criteria were examined to detect possible common features.     

Meckel’s scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years

Aim

To review our practice of Meckel’s Tc-99m pertechnetate scans over 18 years with regard to indications for the test, sensitivity and specificity in our particular referral patients’ population.

Materials and methods

This is a retrospective review of Meckel’s scans performed in two paediatric tertiary care teaching hospitals from April 1993 to March 2011 and followed up till October 2011. The scan was performed according to published international guidelines. 183 patients were included in this study. We classified the patients into two groups: group 1, which included 77 patients (42 %) presenting with painless per rectum bleeding, and group 2, which included 106 patients (58 %) presenting with other non-specific symptoms (e.g. abdominal pain, possibly associated with nausea and/or vomiting, failure to thrive). Data were analysed using Chi square test, considering P value less than 0.05 as significant. The age of the patients ranged from 4 days to 16.5 years (median 3 years).

Results

161 of the total 183 children on the study (88 %) had a negative Meckel’s scan, and 22 children (12 %) had a positive scan. In the group with a positive Meckel’s scan (22 children), all patients underwent surgical exploration and ectopic gastric mucosa was found in 17 cases (77 %, true positives). In the remaining 5 cases (23 %), there was no evidence of ectopic gastric mucosa (false positives). Within the group with a negative scan, 8 children (5 %) underwent surgery; only 1 child had a ectopic gastric mucosa detected following surgery (false negative). In other 52 children (32 %) of the group with a negative Meckel’s scan, an endoscopy was done, which showed a normal result in 21 children and was abnormal in 31 children. Of the remaining 101 (63 %) children with a negative Meckel’s scan, 74 children (46 %) improved without any further intervention. In 13 cases (8 %), other pathologies were identified. The sensitivity and specificity of the Meckel’s scan for ectopic gastric mucosa were 94 and 97 %, respectively. The Meckel’s scan was positive in 26 % of the patients of group 1 and in only 2 % patients of group 2. The difference between the two groups was highly significant [P < 0.0001 (Yates-corrected Chi square); odds ratio 18 (Woolf-logit method 95 % CI)].

Conclusion

The Meckel’s scan retains a high diagnostic accuracy in children for detecting a Meckel’s diverticulum with ectopic gastric mucosa within it, when performed according to the recommended guidelines. The test yields its highest positive result in children presenting with significant per rectum bleeding.     

Pediatric appendicitis in "real-time": the value of sonography in diagnosis and treatment.

OBJECTIVES: To determine the accuracy of sonography in the diagnosis of clinically equivocal appendicitis, and to identify the factors leading to an inaccurate ultrasound diagnosis. The impact of sonographic findings on clinical management and outcome of children with appendicitis is examined. METHODS: We performed a retrospective review of 317 children who attended the emergency department (ED) of a children's hospital for acute abdominal pain for which acute appendicitis was the main differential diagnosis. They had ultrasound because the diagnosis was uncertain clinically. RESULTS: The positive predictive value of ultrasound for appendicitis was 0.92, and the negative predictive value was 0.88. The sensitivity and specificity could not be determined because there were 43 patients with equivocal ultrasound results. The pitfalls hindering the accuracy of ultrasound diagnosis included a high incidence of perforated appendicitis at presentation, the retrocecal appendix, and other technical factors such as abdominal guarding, excessive bowel gas, obesity, inadequate bladder filling, and the uncooperative patient. When ultrasound findings were combined with clinical judgment in clinical management, there were only five cases of non-therapeutic laparotomy and eight cases of delayed surgery due to missed diagnosis in our cohort. CONCLUSIONS: Ultrasound is a useful for the evaluation of acute abdominal pain in children. However, in the setting of a pediatric hospital ED, the accuracy of ultrasound and its ability to improve early hospital triage may be reduced. Repeated clinical review is still essential and in selected cases, appendiceal CT scan may be required to guide therapeutic decision making.     

Can parents do a throat culture?

Throat swabs for Group A beta-hemolytic Streptococcus were obtained from 98 patients, ages 4 to 17 years, both by their parents and by physician investigators. Compared with results obtained by physicians, there was a false negative rate of 32% (P less than 0.001) for the parents. The discrepancy was greater in the youngest age group (38% false negative rate in the 4- to 8-year-olds) compared with older children (P less than 0.001). The overall sensitivity and negative predictive value for the parent-obtained swabs were 68 and 45%, respectively. In the 4- to 8-year-old group, these values were 62 and 37%, respectively. Because there were no false positives the positive predictive value was 100%. We conclude that the false negative rate for untrained parents obtaining throat swabs is too high to warrant the implementation of home testing for Group A streptococci.     

Routine use of PET scans after completion of therapy in pediatric Hodgkin disease results in a high false positive rate

PURPOSE: Fluoro-2-deoxy-D-glucose positron emission tomography scans are becoming standard of care in the evaluation of Hodgkin disease (HD). The frequency of false positive (FP) PET scans in pediatric HD after completion of therapy has not been well studied. PATIENTS AND METHODS: All PET scan reports on pediatric HD patients at our institution between February 2000 and February 2005 were retrospectively reviewed. Scans were considered positive if the interpretation was most consistent with malignancy. FP results were determined by pathologic evaluation, resolution on scan, or absence of disease progression over at least 1 year without intervention. RESULTS: We reviewed 255 PET scans on 47 patients, including 156 posttherapy scans on 34 patients. Positive predictive value for scans obtained during routine follow-up was 11%, with an FP rate of 16%. Identifiable etiologies of FP scans included: fibrosis, progressive transformation of germinal centers, abdominal wall hernia, appendicitis, thymus and HIV associated lymphadenopathy. CONCLUSIONS: Routine PET scans after completion of therapy in pediatric HD patients have a low positive predictive value and a high FP rate. Prospective studies are needed to reduce the ambiguity of positive results. In the interim, positive PET scans after treatment should be interpreted cautiously and therapeutic decisions should not be made without histologic confirmation.     

Can parents accurately screen children at risk of developmental delay?

Aim:   To evaluate the validity and potential value of the parent-completed Infant/Child Monitoring Questionnaire (IMQ) as a screening measure for developmental delay in high-risk infants.
Methods:   One hundred and forty-one term infants born with moderate or severe newborn encephalopathy (NE) and 374 randomly selected comparison infants were administered a Griffiths Mental Development Scales (GMDS) assessment and an IMQ concurrently. Concordance of classifications between measures was compared for agreement, sensitivity, specificity, positive predictive value, negative predictive value, false positives and false negatives.
Results:   Overall, sensitivity and specificity of the IMQ for infants with NE averaged across all age groups was 87%, positive predictive value 57% and negative predictive value 97%. The IMQ did not perform as well for comparison infants with a sensitivity of 50%, specificity 94%, positive predictive value 15% and negative predictive value 99% averaged across all age groups. Overall under-referral for infants with NE was 13%, compared with 50% for comparison infants.
Conclusions:   Use of the IMQ as an accurate screening measure in infants 'at risk' of developmental delay is supported. The low sensitivity of the IMQ for the comparison infants indicates a need for caution when considering its application for general population screening.     

Normal patterns of 18F-FDG appendiceal uptake in children

Background

Prior to interpreting PET/CT, it is crucial to understand the normal biodistribution of fluorodeoxyglucose (FDG). It is also important to realize that the normal biodistribution can vary between adults and children. Although many studies have defined normal patterns of pediatric FDG uptake in structures like the thymus, brown fat and bone marrow, patterns of normal pediatric bowel activity, specifically uptake within the appendix, have not been well described. Active lymphoid tissue has increased FDG uptake when compared with inactive tissue. Since children have more active lymphoid tissue than adults, and because the appendix contains aggregated lymphoid tissue, we postulated that appendiceal uptake may be increased in pediatric patients.

Objective

To define the normal level of appendiceal FDG activity in children by evaluating a series of consecutive FDG PET/CT scans performed for other indications.

Materials and methods

After obtaining IRB approval, we retrospectively reviewed 128 consecutive whole-body pediatric FDG PET/CT examinations obtained for a variety of clinical indications. CT scans on which the appendix could not be visualized were excluded from analysis. CT scans on which the appendix could be visualized were evaluated for underlying appendiceal pathology. Studies with appendiceal or periappendiceal pathology by CT criteria were excluded. A region of interest (ROI) was placed over a portion of each appendix and appendiceal maximum standardized uptake value (SUVmax) was calculated. If an adjacent loop of bowel activity interfered with accurate measurements of the appendix SUVmax, the scan was excluded from the analysis. A chart review was performed on patients with elevated appendiceal SUVmax values to ensure that the patients did not have clinical symptomatology suggestive of acute appendicitis. When the appendix or a portion of the appendix could be visualized and accurately measured, the SUVmax was determined. SUVmax of the appendix was compared to the SUVmax of normal liver and ratios were recorded.

Results

A total of 128 scans were reviewed, patient ages 1 month to 21 years (mean age: 11.6 years). Thirty-one scans were excluded because of inability to visualize the appendix on CT. No scans were excluded for appendiceal/periappendiceal pathology on CT or chart review. No scans had to be excluded for inability to obtain an accurate SUVmax measurement because measurements were calculated on portions of the appendix separate from adjacent bowel using small ROIs. Maximum appendiceal SUVs ranged from 0.5 to 9.4 (mean: 2.2) with an appendix-to-liver background ratio ranging from 0.3 to 3.1 (mean: 1.1).

Conclusion

FDG uptake in the appendix is typically similar to that of background activity. However, slight variations in appendiceal FDG uptake do occur, which should not be misinterpreted as pathological.     

Utility of PET scans to predict disease relapse in pediatric patients with Hodgkin lymphoma

BACKGROUND: Positron emission tomography (PET) differentiates normal from abnormal cells based on metabolic activity. Numerous studies report that PET scan offers increased sensitivity, specificity and predictive values as compared to computed tomography (CT) in adult lymphoma patients. PROCEDURE: Twenty-three consecutive pediatric Hodgkin lymphoma (HL) patients were evaluated with PET scan either at diagnosis or during treatment, then at therapy completion and in follow-up. RESULTS: Twenty two of the 23 patients had a negative PET scan at the end of therapy; however, ten later developed a positive scan for a total of 11 (47.8%) patients with a positive post treatment PET scan. Six tissue biopsies were performed in five patients; four specimens were negative for disease and two confirmed HL relapse. Six patients were monitored clinically and remained asymptomatic; four had resolution of abnormalities on repeat PET while two had persistently positive, but stable PET scan findings and continue to be in remission at 11 and 40 months following treatment. Twelve (52.2%) patients of the original cohort have had consistently negative PET scans and have not relapsed. CONCLUSIONS: PET is a sensitive (100%), but not a specific (57.1%) method for evaluating post-treatment pediatric HL patients with a strong negative predictive value (NPV; 100%), but poor positive predictive value (PPV; 18.2%). We do not recommend treatment decisions be based solely on PET scan results.     

Indium-111 bleomycin tumor scanning in lymphoma.

A new radiopharmaceutical, indium-111 labeled bleomycin (IB), was evaluated as a tumor-imaging agent in 55 patients with lymphoma. Overall disease activity was correctly identified in 79% of 75 whole-body scan obtained 48 hours after intravenous administration of IB. Serial scans in 19 patients accurately reflected changes in their disease status. Lymphatic and soft tissues sites of involvement both above and below the diaphragm were most readily identified by scanning. Bone marrow and hepatic involvements were more difficult to detect because of normal tissue background in the considered organs. Five patients manifested diffuse pulmonary uptake of IB and only in one case was it explained. To determine the accuracy of scanning with IB, we evaluated 731 individual sites of potential tumor involvement with these results: true positives 90%, false negatives 10%, false positives 4%, and true negatives 96%. Thus, tumor scanning with indium-111 bleomycin is an important new technique for the initial staging and serial evaluation of patients with lymphoma.     

Utility of FDG-PET/CT in follow-up of children treated for Hodgkin and non-Hodgkin lymphoma

Positron emission tomography using F-flurodeoxyglucose (FDG-PET) is considered an excellent tool for staging and monitoring disease status in adults with lymphoma. We retrospectively reviewed results of PET/CT and diagnostic computed tomography (CT) scans performed during follow-up after completion of therapy in 41 children <18 years of age with Hodgkin lymphoma and non-Hodgkin lymphoma. PET/CT scan with uptake greater than that of the liver was considered positive. Uptake that increased over the background but less than in the liver was equivocal. Clinical outcomes were obtained from medical records. Thirteen (32%) had a positive PET/CT scan and an equal number had equivocal scans in a median follow-up of 2.3 years. Diagnostic CT scans revealed new findings in 13 (32%) and persistent abnormalities in 21 (51%) of the children. Five children developed recurrent disease, and one developed a second cancer. No children with equivocal positivity developed recurrent disease. PET/CT scan was 95% sensitive, with a positive predictive value (PPV) of 53%. Diagnostic CT was 79% sensitive, with a PPV of 52%. We conclude that a negative PET/CT scan during routine follow-up for lymphoma in children strongly suggests absence of recurrence but a positive PET/CT and diagnostic CT scans have low PPV and should be interpreted with caution in this setting.     

Ultrasonographic prediction of the presence and severity of esophageal varices in children

Twenty-eight consecutive children with either chronic liver disease or portal vein obstruction were investigated to study the presence of gastroesophageal collaterals due to portal hypertension by ultrasound and endoscopy. Sonographic measurements of the ratio of the lesser omentum thickness to aortic diameter (LO/Ad) and of portal vein diameter to body surface (Pv/m2) were significantly higher in children with esophageal varices than in those without varices. With a lower limit for the LO/Ad ratio of 1.3, no false negatives and only three false positives (91% predictive value of esophageal varices) could be detected. The combination of LO/Ad and Pv/m2 would exclude the possibility of detecting esophageal varices if the LO/Ad ratio is less than 1.8 and the Pv/m2 is less than 12 mm. All children with an LO/Ad ratio greater than 1.9 had varices. Even in the presence of an overlap between children with small and large varices, it is possible to identify with high probability a child with large varices if the LO/Ad ratio is greater than 2.5. This study confirms the value of ultrasound in the diagnosis and management of children with portal hypertension and suggests an algorithm to screen children with small and large varices.     

Test characteristics of the respiratory syncytial virus enzyme-linked immunoabsorbent assay in febrile infants < or = 60 days of age

The test characteristics of rapid tests for respiratory syncytial virus (RSV) in infants may differ from older children secondary to a lower likelihood of previous illness with RSV. Our main goal was to establish the test characteristics of the RSV Abbott Testpack (TP) enzyme-linked immunoabsorbent assay (EIA) in febrile infants < or = 60 days of age. Our secondary goal was to determine the likelihood of RSV given a particular clinical syndrome and a negative or positive EIA. A prospective sample of infants with a temperature > or = 38.0 degrees C was evaluated during 2 successive RSV seasons. Conventional tissue and shell vial viral cultures were utilized as the reference standard. The RSV Abbott Testpack EIA had a sensitivity of 75% (95% CI 60-90%), a specificity of 98% (95% CI 96-100%), a positive predictive value of 89% (95% CI 77-100%), a negative predictive value of 95% (95% CI 91-98%), a likelihood ratio for a positive test of 35.5 (95% CI 11.4-110.7), and a likelihood ratio for a negative test of 0.26 (95% CI 0.14-0.47). Even with a negative EIA, patients with lower and upper respiratory tract illness still had a 22.3% and 5.5% chance of harboring RSV, respectively. The RSV Abbott Testpack is a useful diagnostic tool in the detection of RSV in febrile infants but has limitations. During months typically associated with RSV disease, a positive RSV TP indicates a high likelihood of illness, but clinicians should be wary of false negatives.     

Radiographic evaluation for suspected cerebrospinal fluid shunt obstruction

OBJECTIVE: To measure the predictive value of plain radiographs (shunt series) and computed tomography (CT) scans in a group of children undergoing evaluation for suspected shunt obstruction in a tertiary care pediatric emergency department (ED). METHODS: Radiology reports were reviewed for all ED patients who underwent a shunt series over an 18-month period. Two investigators categorized all reports as normal, possibly abnormal (eg, kink in shunt tubing, no prior CT scan for comparison), or abnormal (with definite evidence of shunt dysfunction, such as shunt tubing disconnection and increase in ventricular size since prior CT scan). Studies for which there was disagreement were re-read independently by a pediatric radiologist. Medical records were reviewed to determine outcomes. RESULTS: A total of 233 patients had shunt series and CT scans ordered. Of these, 60 patients subsequently required surgery for shunt obstruction. The shunt series revealed abnormalities in 12 patients (sensitivity, 20%; negative predictive value, 22%), whereas CT scans showed definite or possible abnormalities in 50 patients (sensitivity, 83%; negative predictive value, 93%). Combined, the two tests detected 53 shunt obstructions (sensitivity, 88%; negative predictive value, 95%). Two obstructed patients had abnormalities on shunt series that would not have been suspected after physical examination or CT scan. CONCLUSIONS: Over one quarter of pediatric ED patients evaluated radiographically for suspected shunt obstruction required surgical management. One in eight obstructed patients had normal radiographic studies. Routine performance of shunt series had a low overall yield but on rare occasions detected abnormalities that were missed by CT. Prospective studies are needed to improve the use of radiographic tests for shunt evaluation and determine clinical indications for further workup when studies are normal.     

The value of determining anti-gliadin antibodies as well as carotene and xylose blood levels in various phases of celiac disease

The usefulness of measuring xylosaemia, carotenaemia and the antigliadin antibodies in the diagnosis and monitoring of coeliac diseases has been examined, 89 children, 57 with aspecific chronic diarrhoea and 32 with coeliachia were examined. The xylose proved less sensitive (80%) and less specific (84.2%) than carotenaemia (respectively: sensitivity 86.6% and specificity 87.7%). Nevertheless, considering the by no means negligible percentage of false positives and false negatives encountered with both techniques, it should be reiterated that these tests have a purely orientative value, whereas measurement of serum AGA may be considered a highly reliable investigation for selective children to be submitted to biopsy, considering the high sensitivity (AGA IgG 100%; AGA IgA 90.9%) and specificity (AGA IgG 85%; AGA IgA 100%) observed in the present series.     

Specificity and indications of bone scan in non-neoplastic bone and joint disease in children. A study of seventy cases

We studied 70 bone scans in pediatric patients to define the indications of this procedure in non-neoplastic disease. Sensitivity of bone scans in infections proved outstanding except in children under one year of age. Eighty-nine per cent of children with pain and fever and a positive bone scan had either an infection or osteochondritis. The same symptoms with a negative bone scan indicated either transient synovitis of the hip or the absence of bone lesions in 83% of cases. Children with pain as the only symptoms and a negative bone scan consistently had either transient synovitis of the hip, or normal bones and joints (100% of cases). Eighty-two per cent of children with pain and a positive bone scan had an infection or osteochondritis. Indications of bone scanning vary according to clinical features and include all children with functional impairment, pain and fever, and isolated limps with no obvious cause.     

彩色多普勒超声诊断小儿急性阑尾炎的临床应用研究

目的探讨彩色多普勒超声诊断小儿急性阑尾炎的临床应用。方法对临床拟诊的78例急性阑尾炎的患儿全部行彩色多普勒超声检查以明确诊断及鉴别诊断。结果78例临床拟诊的急性阑尾炎病人，经彩色多普勒超声检查诊断为急性阑尾炎的51例，全部行手术治疗，经手术及术后病理检查50例证实为急性阑尾炎。本组出现假阳性1例，假阴性1例，准确率为97．7％。结论采用无创伤性、简单安全的彩色多普勒超声诊断小儿急性阑尾炎可靠、准确，值得推广应用。     

Diagnosing appendicitis in children with acute abdominal pain

Differentiating acute appendicitis from other causes of acute abdominal pain in children frequently remains unsatisfactory. To determine whether initial historical and physical examination findings might predict final diagnoses, 246 patients with complaints of nontraumatic and nonrecurrent acute abdominal pain were studied. All were between three and 18 years of age and had presented to a hospital-based pediatric emergency department. Each family was telephoned an average of 5.1 days after the visit to determine the patient's subsequent clinical course; operative notes and pathology reports were reviewed for patients receiving surgery. Of these patients with acute abdominal pain, both fever and vomiting were present in 18 of the 24 who eventually had diagnoses of appendicitis, compared with 49 of 222 patients with other final diagnoses (P less than 0.01, with negative predictive value 0.97, sensitivity 0.75, and specificity 0.78, but positive predictive value only 0.27). The duration of the pain at presentation and the frequency of other symptoms (eg, diarrhea, dysuria, anorexia, and lethargy) were unrelated, however, to final diagnosis, as was the duration of the pain and whether abdominal tenderness initially was localized or generalized. Nonruptured appendicitis was generally indistinguishable from ruptured appendicitis preoperatively, by both duration and symptoms. Boys were found more likely to have appendicitis (with or without rupture) than girls (18/118 or 15%, vs. 6/128 or 5%, P less than 0.05). In conclusion, fever and vomiting were noted at presentation more frequently in children with appendicitis than in children with other causes of acute abdominal pain.(ABSTRACT TRUNCATED AT 250 WORDS)