Ultrasound and computed tomography in differentiating between simple and complicated appendicitis in pediatric patients

Objectives This study aims to measure the diagnostic accuracy and reliability of US and CT in diagnosing complicated appendicitis among pediatric patients and to find the performance of the imaging modalities in detecting complication signs. Methods a systematic review and meta-analysis were done on 15 eligible studies from the Medline Database concerning pediatric appendicitis and its complications. Studies either provided an overall estimate of sensitivity and specificity of the imaging modality or addressed signs of complicated appendicitis The reference standard employed was either surgical findings or histopathology reports. Results The review included assessments of 4,497 pediatric patients, with 285 undergoing CT and 4,212 undergoing US imaging. CT demonstrated sensitivities of 62% and 68.4%, and specificities of 81% and 92.4%. US showed sensitivities of 33.9% to 51.5% and specificities ranging from 68.8% to 95%. The ultrasound's ability to detect appendiceal wall diameter > 5 mm showed the highest sensitivity (99.4%), while the conglomerate sign indicated the highest specificity (99.9%). Conclusion The findings suggest that both US and CT exhibit higher specificity than sensitivity in diagnosing complicated appendicitis in pediatric patients. Given its favorable specificity, non-invasiveness, and lack of radiation exposure, US should be the first-line imaging modality in suspected cases of pediatric appendicitis. CT, offering robust specificity, should be reserved for ambiguous cases where US results are inconclusive. These insights underscore the critical role of precise imaging modalities in enhancing diagnostic accuracy, reducing unnecessary surgeries, and improving clinical outcomes in pediatric appendicitis management.