Saudi medical journal · 2026
Evaluating the Diagnostic Accuracy of Ultrasound and Clinical Predictors in Pediatric Acute Tip Appendicitis: A retrospective study from a tertiary center in Saudi Arabia.
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Qarnayn Abdullah M Abu, Aljadaan Saud A, Alaqeel Suliaman M, Alshehri Faisal S, Algosear Abdullrzak N, Alharthi Waleed A, Alsukait Munirah A, AlShaya Kholoud S
Аннотация
OBJECTIVE: To examines the diagnostic accuracy of ultrasound (US) and the clinical characteristics of pediatric ATA. Acute tip appendicitis (ATA), a rare form of appendiceal inflammation confined to the distal tip, presents with atypical symptoms and is difficult to diagnose. The Confirmation often relies on imaging and surgical pathology.
METHODS: A Retrospective cross-sectional study conducted at a tertiary hospital in Riyadh, Saudi Arabia, from 2020 to 2024. Among 4,224 pediatric patients with acute appendicitis under 14 years, and our sample size of 59 patients were diagnosed with ATA by US. Firth logistic regression was used to reduce bias in the small-sample analysis.
RESULTS: Among 59 children diagnosed with acute tip appendicitis (ATA) by US, 32 were confirmed by pathology. Ultrasound demonstrated a sensitivity of 65.6%, specificity of 81.5%, and an area under the receiver operating characteristic curve (AUC) of 0.804. Firth logistic regression identified abdominal pain (adjusted odds ratio [Adj OR] = 12.7; 95% confidence interval [CI]: 0.918-183.2) as a positive predictor, while higher fever (Adj OR = 0.37; 95% CI: 0.151-0.765) was inversely associated with confirmed ATA. US accuracy was not significantly associated with a return to the emergency department within 30 days (p = 0.826).
CONCLUSION: The ATA in children often lacks classic signs like high fever. US has high specificity but moderate sensitivity. Firth logistic regression was effective for analyzing small samples. Greater clinical awareness and optimized imaging use are needed for early detection and improved outcomes.
METHODS: A Retrospective cross-sectional study conducted at a tertiary hospital in Riyadh, Saudi Arabia, from 2020 to 2024. Among 4,224 pediatric patients with acute appendicitis under 14 years, and our sample size of 59 patients were diagnosed with ATA by US. Firth logistic regression was used to reduce bias in the small-sample analysis.
RESULTS: Among 59 children diagnosed with acute tip appendicitis (ATA) by US, 32 were confirmed by pathology. Ultrasound demonstrated a sensitivity of 65.6%, specificity of 81.5%, and an area under the receiver operating characteristic curve (AUC) of 0.804. Firth logistic regression identified abdominal pain (adjusted odds ratio [Adj OR] = 12.7; 95% confidence interval [CI]: 0.918-183.2) as a positive predictor, while higher fever (Adj OR = 0.37; 95% CI: 0.151-0.765) was inversely associated with confirmed ATA. US accuracy was not significantly associated with a return to the emergency department within 30 days (p = 0.826).
CONCLUSION: The ATA in children often lacks classic signs like high fever. US has high specificity but moderate sensitivity. Firth logistic regression was effective for analyzing small samples. Greater clinical awareness and optimized imaging use are needed for early detection and improved outcomes.