• Antonia E Stephen, Dorry L Segev, Daniel P Ryan, Mark E Mullins, Samuel H Kim, Jay J Schnitzer, and Daniel P Doody.
• Department of Pediatric Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114-2696, USA.
• J. Pediatr. Surg. 2003 Mar 1;38(3):367-71; discsussion 367-71.

PurposeThe aim of this study was to determine if focused appendiceal computed tomography with colon contrast (FACT-CC) increases the accuracy of the preoperative diagnosis of acute appendicitis in children.MethodsA 5-year retrospective review was conducted of a university hospital database of 283 patients (age 0.8 to 19.3 years; mean, 11.3 years) treated with appendectomy for presumed acute appendicitis.ResultsOf the 283 patients in whom appendectomies were performed, 268 were confirmed by pathologic analysis of the specimen to have acute appendicitis for a diagnostic accuracy in our institution of 94.7%. Ninety-six patients (34%) underwent FACT-CC scans as part of their preoperative evaluation. The sensitivity of the computed tomography (CT) scan was 94.6%, and the positive predictive value was 95.6%. In girls older than 10 years, CT imaging was not significantly more accurate in predicting appendicitis than examination alone (93.9% v. 87.5%; P =.46).ConclusionsPreoperative FACT-CC did not increase the accuracy in diagnosing appendicitis when compared with patients diagnosed by history, physical examination and laboratory studies. If there was a strong suspicion of appendicitis, a negative CT scan did not exclude the diagnosis of appendicitis. However, focused appendiceal CT scan is a sensitive test with a high positive predictive value and may be useful in a patient with an atypical history or examination.Copyright 2003, Elsevier Science (USA). All rights reserved.

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