WOFAPS 2025 8th World Congress of Pediatric Surgery

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Oral Presentation - 137

Diagnostic Efficacy of Imaging Studies and Laboratory Tests on Childhood Acute Appendicitis: A Retrospective Analysis of 675 patients

Mehmet Metin 1, Nurcan Çoşkun 2, Hülya İpek 1, Gül Doğan 1, Çağatay Evrim Afşarlar 1
1 Hitit University Faculty of Medicine,Department of Pediatric Surgery
2 Hitit University Çorum Training and Research Hospital, Department of Pediatric Surgery

Purpose: Imaging studies and laboratory tests are frequently used in the diagnosis of acute appendicitis in childhood. In this study, we aimed to compare ultrasonography (US), computed tomography (CT), and laboratory studies with histopathological results of the patients who underwent appendectomy, and to investigate their efficacy in accurate diagnosis.

Methods: A total of 675 patients who underwent appendectomy <18 years of age were retrospectively investigated between January 2019 and December 2024. The compatibility of US, CT, and concurrent US and CT imaging studies with histopathological diagnosis was evaluated. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated. McNemar test, Kappa coefficient, GWET AC1 and Intraclass Correlation Coefficient (ICC) were used in the compatibility analyses. In addition, complete blood count parameters and C-reactive protein (CRP) values were compared with histopathology results.

Results: CT showed 76.8% sensitivity and 71.7% specificity. US demonstrated higher sensitivity (79.9%) but lower specificity (51.1%). The concurrent US and CT showed the highest specificity (93.1%), accuracy (78.9%), PPV (95.7%) and NPV (61.4%) values. The Kappa coefficient for CT, US and concurrent US and CT were 0.351, 0.258 and 0.574, respectively. Inflammatory markers CRP, white blood cell and neutrophil counts and neutrophil to lymphocyte ratio showed significant differences in supporting the appendicitis diagnosis (P<0.001).

Conclusion: In the diagnosis of appendicitis in children, US is a noninvasive and highly sensitive method, but its specificity is low. CT offers higher accuracy and histopathological concordance, however, should be used with caution due to ionizing radiation risk. When there is high index of suspicion concurrent use of US and CT increases diagnostic accuracy, reduces false-negative/positive results, and prevents unnecessary laparotomies. Appropriate imaging strategy should be chosen depending on age, clinical and laboratory findings of children with suspected appendicitis.

Keywords: acute appendicitis, children, US, CT, diagnostic accuracy

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