| Abstract: | Purpose: To evaluate a diagnostic strategy for suspected appendicitis in children that uses the clinical examination first, followed by ultrasound (US) and, for selected cases, magnetic resonance imaging (MRI) Materials and Methods: One hundred and sixty-six children that presented with signs and symptoms suggestive of acute appendicitis were included in the study. Mean age (standard deviation) was 9. 15 years (2. 78) and age range was 1 to 13 years. Cases classified as suggestive of appendicitis according to clinical exams were referred to surgery, and cases not suggestive were discharged. Unclear cases were evaluated using US. In cases in which US findings were inconclusive, patients underwent MRI. This study was approved by the Ethics Committee of the institution where it was conducted, and informed consent was obtained from the patients and their guardians. Sensitivity, specificity, positive and negative predictive values, as well as diagnostic accuracy of the strategy, were calculated according to final diagnoses. Kappa statistics was used to evaluate agreement between diagnostic test and disease. The level of statistical significance was set at P equal to, or lower than, 0. 05. Results: Of the 166 patients evaluated, 78 (47%) had acute appendicitis and 88 (53%) had other diseases. Forty-seven boys (60%) and 31 girls (40%) had appendicitis. The strategy under study had a sensitivity of 96%, specificity of 100%, positive predictive value of 100%, negative predictive value of 97%, and accuracy of 98%. There were no misdiagnoses during the clinical stage; US imaging studies had 3 false negative results. Eight patients underwent MRI, and 2 were discharged after the normal appendix was detected; 6 were kept under clinical observation due to inconclusive findings; during observation, one patient had a final diagnosis of appendicitis. Conclusions: Clinical and ultrasound evaluations were highly accurate for the diagnosis of appendicitis. Further studies should evaluate the importance of MRI to diagnose or rule out acute appendicitis.
Objetivo: Avaliar uma estratégia de investigação diagnóstica da apendicite em crianças que leve em conta inicialmente o exame clínico, após a ultrassonografia (US) e em casos selecionados, a ressonância magnética (RM). Materiais e Métodos: Participaram 166 pacientes com suspeita de apendicite aguda, com idade média (desvio padrão) de 9,15 anos (2,78), tendo idade entre 1 e 13 anos. Pela clínica casos considerados sugestivos foram encaminhados para cirurgia e casos não sugestivos foram liberados. Casos duvidosos foram avaliados pela US. Nos casos em que a US foi inconclusiva, os pacientes foram avaliados pela RM. O estudo foi aprovado pelo comitê de ética da instituição e consentimentos informados foram obtidos dos pacientes e seus responsáveis. Sensibilidade, especificidade, valores preditivos positivo e negativo, assim como acurácia da estratégia basearam-se no diagnóstico final. Foi realizado teste de Kappa para avaliar a concordância entre o teste diagnóstico e a doença. O valor de P igual ou menor que 0,05 sendo indicativo de diferença estatística significante. Resultados: Nos 166 pacientes avaliados, 78 tiveram apendicite aguda (47%) e 88 apresentaram outras doenças (53%). Quarenta e sete meninos (60%) e 31 meninas (40%) tiveram apendicite.A estratégia adotada teve sensibilidade de 96%, especificidade 100%, valor preditivo positivo 100%, valor preditivo negativo 97 % e a acurácia de 98%. Na etapa clínica não ocorreu erro no teste diagnóstico; na etapa de imagem por US ocorreram 3 erros do tipo falso negativo; 8 pacientes foram submetidos a RM, onde 2 foram liberados após identificação de apêndice cecal normal e 6 foram submetidos a observação clínica devido a achados duvidosos; nesta observação um paciente teve diagnóstico final de apendicite. Conclusões: As avaliações clínica e ultrassonográfica tiveram alta acurácia no diagnóstico da apendicite na maioria dos casos. Estudos futuros são necessários para melhor avaliar a importância da RM no diagnóstico e exclusão da apendicite aguda. |
