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| |  AAP: False Negative Computed Tomography Results for Appendicitis More Likely in Thin Children By Alison Palkhivala Special to DG News SAN FRANCISCO, CA -- October 25, 2001 -- Thin children are more likely to have false negative results from computed tomography scans for acute appendicitis, according to new research. Computed tomography (CT) scans are commonly used among children and adults to aid in the diagnosis of acute appendicitis. However, reliance on these scans in thin children might be dangerous. According to Brian F. Gilchrist, MD, from the pediatric surgery department of the State University of New York (SUNY) Downstate Medical Center in Brooklyn, New York, United States, and colleagues, their clinical experience has revealed many false positive results when using CT scans to diagnose acute appendicitis in children. Of greater concern is the rate of false negative results of CT scans when diagnosing acute appendicitis. Dr. Gilchrist presented his team’s latest findings with respect to this issue here this week at the National Conference and Exhibition of the American Academy of Pediatrics (AAP). The investigators performed a retrospective analysis of the charts of the 154 children (aged four to 17) who underwent positive appendectomies at their institution in 1999. All CT scans were ordered before patients were evaluated by a pediatric surgeon, and 11 of these patients had had CT scans prior to surgery that showed no signs of acute appendicitis. The CT scan results were interpreted by experienced radiologists in all 11 of these cases. These patients were operated on nonetheless within 24 hours because of persistent physical findings, and histological analysis revealed that appendicitis was indeed present in all 11 of these children. They were all below the 30th percentile with respect to their fat body mass (FBM). Dr. Gilchrist and colleagues speculate that low body fat might have contributed to the false negative CT scan readings because body fat is important in CT scans for the delineation of intra-abdominal organs. Early inflammation could easily be missed in the presence of a lack of adipose tissue. As a result, they warn physicians that thin children with physical signs of appendicitis for whom CT scan results are negative may indeed be suffering from this condition. They note that missed acute appendicitis is the most frequently litigated case against pediatric surgeons.
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