Accuracyof Ultrasound and CT scans in the Diagnosis of Acute Appendicitis in Children: A Systematic Review

Abstract

Acute appendicitis (AA) is the most common surgical
emergency in childhood. Accurate and early diagnosis is
important because any delay in diagnosis may lead to
perforation or abscess formation. Today, abdominal
ultrasonography (US) and computed tomography (CT)
scans are the most common imaging methods used for
diagnosis. The aim of this study was to evaluate the
accuracy of US and CT scans in the diagnosis of AA in
children. We started our research by using online
libraries as our database. We searched PubMed, Google
Scholar, the Cochrane Library, and the Web of Science
for our data collection. We used both the medical
subject headings (MESH) and regular keywords. Our
review investigated English-language articles regarding
the accuracy of US and CT scans in the diagnosis of AA
in children (2013-2023) according to the Preferred
Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) 2020 guidelines. Articles were
screened by title, abstract, inclusion and exclusion
criteria, and quality assessment tools. The search
identified 513 studies; eight were eligible for inclusion
in the analysis. A total of 3341 pediatric patients were
included across the eight observational studies in our
systematic reviews. The included articles revealed that
low-dose CT showed the highest accuracy in the
diagnosis of AA. Whereas the US showed the lowest.
However, the combination of US as the primary
examination followed by CT in a non-diagnostic US
yielded the highest sensitivity, specificity, and accuracy.
Also, some studies revealed that several factors
decreased the sensitivity of CT and US in diagnosing AA
in children, like different hospital settings, the
radiologist's experience, age, sex, body mass index,
and disease severity. According to the review articles, a
CT scan is the most accurate test and has high
sensitivity and specificity; however, the radiation
hazards are minimized using a CT scan as a primary tool
for diagnosis. US is easily accessible, cost-effective, and
has high sensitivity. However, it is operator-dependent,
has low specificity, and is incompatible with some young
children, so it can be used as a first-choice and low-dose
CT scan in complicated cases and non-diagnostic US.
Ideally, more