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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Acute appendicitis is the most common abdominal disease requiring surgery in the pediatric population&#46; The incidence of appendicitis is relatively high in pediatric patients&#44; and appendicitis in these patients tends to be associated with higher rates of perforation&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#8211;3</span></a> To prevent severe complications&#44; such as perforation&#44; panperitonitis&#44; or intra-abdominal abscess&#44; early diagnosis and prompt treatment&#44; such as appendectomy&#44; are important&#46; In the past&#44; the rate of negative or unnecessary appendectomies was higher&#46; With recent advances in imaging techniques&#44; such as ultrasonography &#40;USG&#41; or computed tomography &#40;CT&#41;&#44; the diagnostic accuracy of acute appendicitis has improved&#44; and negative appendectomy rates have been reduced&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Among these diagnostic modalities&#44; USG has been considered a tool to aid in the diagnosis of acute appendicitis over the last 30 years&#44; and has been particularly useful for diagnosing appendicitis in children&#44; because it uses no ionizing radiation and is non-invasive&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a> However&#44; its diagnostic accuracy varies&#44; depending on the operator&#59; moreover&#44; making a diagnosis based on USG findings is difficult in obese patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#44;5</span></a> Conversely&#44; CT has a high sensitivity and specificity&#59; thus&#44; it is a comparatively accurate diagnostic method&#44; and consequently&#44; the number of CT examinations has increased considerably&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">4&#8211;6</span></a> Nevertheless&#44; CT must be performed carefully&#44; because of the associated radiation exposure&#44; and the consequent risk of cancer&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#8211;8</span></a> Saito et al&#46; reported various methods that are currently used to diagnose pediatric appendicitis at different hospitals&#44; but no clear conclusion could be drawn regarding the effect of age or body mass index &#40;BMI&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> With magnetic resonance imaging &#40;MRI&#41;&#44; there is no exposure to ionizing&#46; The scanner is safe during pregnancy and the result of the examination is reliable and accurate&#46; Nevertheless&#44; MRI is not used widely due to its high costs&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">For these reasons&#44; there is an increasing interest in low-dose CT&#46; Some studies on this subject have been reported&#44; which have focused on diverse diseases&#44; including cardiac or pulmonary diseases&#44; in addition to abdominal diseases&#44; and in various age groups&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">9&#44;10</span></a> Additionally&#44; many reports have evaluated diagnoses made using low-dose CT in adults and adolescents&#44; and these findings have been applied in clinical practice&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#8211;15</span></a> However&#44; no studies have reported the efficacy of using dose CT in the diagnosis of acute appendicitis in children younger than 10 years&#44; including those in early childhood&#44; as previous studies have focused mainly on young adults or adolescents&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore&#44; in the present study&#44; the authors assessed the usefulness and accuracy of low-dose CT for diagnosing acute appendicitis in children&#44; and compared the use of low-dose CT in this context with abdominal USG and standard-dose abdominal CT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and data extraction</span><p id="par0025" class="elsevierStylePara elsevierViewall">Children under 10 years of age who were hospitalized at Chung-Ang University Hospital from March 2005 to December 2014 with clinical suspicion of acute appendicitis were recruited for the study&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> Among those recruited&#44; patients who did not undergo radiological evaluation and those in which the purpose of radiological evaluation was unclear were excluded&#59; thus&#44; 616 patients were identified&#46; Of these&#44; further patients were excluded due to prior appendectomy&#46; The exclusion criteria also comprised patients with a gastrointestinal anomaly that caused structural misperception during radiological interpretation&#59; patients diagnosed by CT imaging&#44; but for whom the accurate radiation dose was not recorded&#59; and those with other gastrointestinal abnormalities&#44; such as intussusceptions or malignancy&#46; A total of 484 patients were assessed&#44; and the clinical manifestations&#44; laboratory findings&#44; imaging findings&#44; operation records&#44; and pathological findings were retrospectively analyzed&#46; Of these&#44; nine children underwent CT after USG &#40;standard-dose CT&#58; five patients&#59; low-dose CT&#58; four patients&#41; and were also excluded&#46; In the remaining 475 patients&#44; a single test was performed&#44; and those patients were included in the study&#46; The definite diagnosis of appendicitis was based on operation records&#44; findings&#44; and pathology records&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Subjects were categorized into two groups according to age classifications developed by the Eunice Kennedy Shriver National Institute of Child Health and Human Development&#58; early childhood &#40;2&#8211;5 years&#41; and middle childhood &#40;6&#8211;10 years&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">BMI was calculated from the patient&#39;s medical chart&#44; and subjects were categorized into three groups according to age-specific BMI&#58; underweight &#40;&#60;5th percentile&#41;&#44; normal weight &#40;5th&#8211;85th percentile&#41;&#44; and overweight &#40;&#62;85th percentile&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This study was conducted after the approval from the Institutional Review Board &#40;IRB&#41; of the Chung-Ang University Hospital &#40;IRB No&#46; 10-014-02-03&#41;&#44; and the need for an informed consent was waived due to the retrospective nature of the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Diagnostic imaging methods</span><p id="par0045" class="elsevierStylePara elsevierViewall">For all study subjects&#44; low-dose and standard-dose CT and abdominal USG were performed and read by expert abdominal radiologists when they presented with acute symptoms&#46; Other expert abdominal radiologists retrospectively reviewed the radiologic images&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">At this institution&#44; CT examinations for acute abdominal pain were performed using intravenous contrast media&#46; No oral or rectal contrast material was used&#46; The CT radiation dose was adjusted according to the child&#39;s age and weight&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> Exams were performed on either a Philips Brilliance iCT 256-slice or Brilliance 64-slice CT scanner &#40;Philips Healthcare&#44; Cleveland&#44; OH&#44; USA&#41; with statistical iterative reconstruction algorithms &#40;iDose&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">4</span></a> The CT protocol used was the size-based scan technique &#40;weight-based&#44; 80&#8211;120 kVp&#41;&#44; with automated Z-axis dose modulation based on the scout image &#40;DoseRight&#44; Philips Healthcare&#44; Cleveland&#44; OH&#44; USA&#41;&#46; Images were reformatted at 3-mm slice thickness in the axial plane and 3-mm slice thickness in the coronal plane for clinical review&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The primary criteria for diagnosis of appendicitis by CT were visualization of an appendix &#62;6<span class="elsevierStyleHsp" style=""></span>mm in diameter&#44; a non-opacified appendiceal lumen&#44; and significant wall enhancement&#46; Secondary criteria on CT included visualization of periappendiceal fat stranding&#44; appendicolith&#44; bowel wall thickening&#44; free fluid&#44; extraluminal air&#44; and the presence of phlegmon or abscess&#44; with the final four criteria constituting evidence of perforation&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">18&#8211;20</span></a> A scan was considered to be negative if a normal appendix was observed or if no secondary signs were seen&#44; even if the appendix could not be visualized&#46; The presence of any alternative diagnosis for patient pain was recorded&#44; excluding mesenteric adenitis&#44; as it is a diagnosis of exclusion&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using SPSS 18&#46;0 statistical software &#40;SPSS Inc&#46;&#44; IL&#44; USA&#41;&#46; ANOVA test&#44; Student&#39;s <span class="elsevierStyleItalic">t</span>-test&#44; Pearson&#39;s <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#44; and analysis of variance were used to analyze differences between groups&#46; The level of statistical significance was set at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Of the 484 children evaluated by radiological methods&#44; nine underwent CT after USG in order to achieve an accurate diagnosis of appendicitis&#46; The diagnosis was followed by appendectomy&#46; In the remaining 475 patients included in the study&#44; a single test was performed&#46; Of these&#44; 297 children were finally diagnosed with acute appendicitis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The mean age and age group were slightly higher in patients who underwent standard-dose CT than in those who underwent low-dose CT or USG &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002 <span class="elsevierStyleItalic">vs</span>&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;022&#41;&#46; However&#44; there were no significant differences in the two CT groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;329 <span class="elsevierStyleItalic">vs</span>&#46; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;000&#41;&#46; In addition&#44; the mean BMI was slightly higher in the standard-dose CT group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46; In laboratory findings&#44; there were significant differences in white blood cell count&#44; absolute neutrophil count&#44; and highly sensitive C-reactive protein levels between the three groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;026&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;029&#44; and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;031&#44; respectively&#41;&#46; Moreover&#44; these values were also not significantly different between the two CT groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;749&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;494&#44; and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;329&#44; respectively&#41;&#46; Other clinical manifestations and laboratory findings are presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Comparison of the radiation dose parameters between the CT groups</span><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding the two groups that underwent CT&#44; in the low-dose CT group&#44; as compared with the standard-dose CT group&#44; the radiation dose was reduced by about 64&#46;2&#37; &#40;2&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;52 <span class="elsevierStyleItalic">vs</span>&#46; 5&#46;76<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;23&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46; However&#44; there was no significant difference between the two groups regarding the tube voltage and tube current &#40;93&#46;58<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;36 <span class="elsevierStyleItalic">vs</span>&#46; 95&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;20&#59; 92&#46;56<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#46;00 <span class="elsevierStyleItalic">vs</span>&#46; 92&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>42&#46;17&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;147 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;940&#44; respectively&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Comparison of the diagnosis of appendicitis based on imaging studies</span><p id="par0080" class="elsevierStylePara elsevierViewall">The usefulness of making a diagnosis of acute appendicitis based on imaging studies was compared in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; There was no significant difference in the sensitivity between the three approaches &#40;95&#46;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 95&#46;0&#37; <span class="elsevierStyleItalic">vs</span>&#46; 94&#46;5&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;794&#41; and we even included the perforated appendix patients&#46; There were significant differences in specificity and positive-predictive value &#40;PPV&#41; between the three groups &#40;94&#46;9&#37; <span class="elsevierStyleItalic">vs</span>&#46; 80&#46;0&#37; <span class="elsevierStyleItalic">vs</span>&#46; 98&#46;8&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#59; and 96&#46;4&#37; <span class="elsevierStyleItalic">vs</span>&#46; 92&#46;7&#37; <span class="elsevierStyleItalic">vs</span>&#46; 97&#46;2&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;019&#41;&#46; However&#44; when the low-dose CT and the standard-dose CT groups were compared&#44; there were no significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;194 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;175&#44; respectively&#41; and both CT imaging modalities were superior when compared with USG&#46; Moreover&#44; there was no significant difference in the negative-predictive value &#40;NPV&#41; between the three groups &#40;93&#46;7&#37; <span class="elsevierStyleItalic">vs</span>&#46; 85&#46;7&#37; <span class="elsevierStyleItalic">vs</span>&#46; 91&#46;3&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;890&#41;&#46; In making a diagnosis of a perforated appendix&#44; both low-dose CT and standard-dose CT were effective and relatively accurate&#46; Thus&#44; both CT modalities were more superior diagnostic tools when compared with USG &#40;100&#46;0&#37; <span class="elsevierStyleItalic">vs</span>&#46; 85&#46;7&#37; <span class="elsevierStyleItalic">vs</span>&#46; 100&#46;0&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Comparison of the diagnostic methods based on the age group</span><p id="par0085" class="elsevierStylePara elsevierViewall">In early childhood&#44; acute appendicitis was accurately diagnosed in all three groups&#58; the low-dose CT group&#44; the standard-dose CT group&#44; and the USG group&#46; In addition&#44; there was no significant difference between the three groups &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; When comparing low-dose with standard-dose CT&#44; there was no significant differences in the sensitivity&#44; specificity&#44; PPV&#44; and NPV between the two groups &#40;100&#37; <span class="elsevierStyleItalic">vs</span>&#46; 95&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;000&#59; 96&#46;4&#37; <span class="elsevierStyleItalic">vs</span>&#46; 100&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;491&#59; 94&#46;1&#37; <span class="elsevierStyleItalic">vs</span>&#46; 100&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;472&#59; and 100&#37; <span class="elsevierStyleItalic">vs</span>&#46; 96&#46;7&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;000&#44; respectively&#41;&#46; Moreover&#44; in middle childhood patients&#44; there was no significant difference in the sensitivity between the three groups &#40;94&#46;8&#37; <span class="elsevierStyleItalic">vs</span>&#46; 92&#46;6&#37; <span class="elsevierStyleItalic">vs</span>&#46; 94&#46;4&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;829&#41;&#46; There was a significant difference in the specificity between the three groups &#40;94&#46;0&#37; <span class="elsevierStyleItalic">vs</span>&#46; 78&#46;6&#37; <span class="elsevierStyleItalic">vs</span>&#46; 98&#46;2&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;011&#41;&#46; However&#44; there was no significant difference &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;341&#41; between the low-dose CT and the standard-dose CT&#46; Both groups showed a higher value than that of the USG group&#46; PPV was significantly different between the USG and the two CT groups &#40;96&#46;8&#37; <span class="elsevierStyleItalic">vs</span>&#46; 89&#46;3&#37; <span class="elsevierStyleItalic">vs</span>&#46; 99&#46;2&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#41;&#46; However&#44; no significant difference in PPV was observed between the two CT groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;323&#41;&#46; Furthermore&#44; NPV was not significantly different between the three groups &#40;90&#46;4&#37; <span class="elsevierStyleItalic">vs</span>&#46; 84&#46;6&#37; <span class="elsevierStyleItalic">vs</span>&#46; 88&#46;7&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;865&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">A comparison of the diagnostic methods based on BMI</span><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the comparison of radiological methods for diagnosis according to age-specific BMI&#46; In patients who were classified as underweight by less than five percentile points&#44; diagnosis was not obtained in only one patient&#46; Accurate diagnoses were made in all three groups&#46; Furthermore&#44; in patients with normal BMI&#44; the sensitivity and NPV showed no significant differences between groups &#40;95&#46;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 92&#46;6&#37; <span class="elsevierStyleItalic">vs</span>&#46; 94&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;795 and 93&#46;2&#37; <span class="elsevierStyleItalic">vs</span>&#46; 71&#46;4&#37; <span class="elsevierStyleItalic">vs</span>&#46; 92&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;336&#44; respectively&#41;&#46; In addition&#44; the specificity and PPV showed no significant differences between the two types of CT doses&#44; and were higher in the CT groups than in the USG group &#40;93&#46;2&#37; <span class="elsevierStyleItalic">vs</span>&#46; 98&#46;3&#37;&#44; respectively&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;207&#59; and 95&#46;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 98&#46;9&#37;&#44; respectively&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;206&#41;&#46; Furthermore&#44; in overweight patients&#44; diagnosis was not obtained in only three patients&#46; However&#44; there was no significant difference in the diagnosis based on the three radiological methods&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">In pediatric patients&#44; it is highly possible that acute appendicitis may present with atypical clinical features&#46; A complication&#44; such as perforated appendix&#44; may manifest as the initial symptom of appendicitis&#46; Therefore&#44; it is crucial to make an early diagnosis of acute appendicitis&#44; particularly in these young patients&#46; To minimize the delay in diagnosis and false-positive and&#47;or false-negative diagnoses&#44; decision on and interpretation of radiological evaluation are essential&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">21&#8211;25</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">However&#44; with the increased interest in the occurrence of cancer due to radiation exposure&#44; there have been concerns about CT scanning&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">7&#44;26&#44;27</span></a> Many studies have indicated the usefulness of low-dose CT in the diagnosis of acute appendicitis&#46; However&#44; no study has reported on the efficacy of using low-dose CT to do so in children&#44; including in infants and young children&#46; In the present study&#44; the authors have examined the usefulness and accuracy of different radiological examinations&#44; depending on the age group and age-specific BMI&#46; Unlike previous studies&#44; it was attempted to confirm that low-dose CT is also effective in the early childhood group&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The present results confirmed that low-dose CT is effective in making a diagnosis of acute appendicitis&#44; including the diagnosis of perforated appendix patients&#44; when compared with USG or standard-dose CT&#46; Following a comparison based on the age group&#44; it was also confirmed to be effective in both early childhood and middle childhood groups&#46; In addition&#44; in a comparison based on the age-specific BMI&#44; low-dose CT was confirmed to be effective in making a diagnosis of acute appendicitis not only in underweight patients&#44; but also in overweight patients&#46; Low-dose CT was effective in making a diagnosis in all patients&#44; particularly in those whose BMI was above the 95th percentile&#46; In all cases&#44; low-dose CT was shown to be more effective than or similarly effective as standard-dose CT or USG in terms of sensitivity&#44; specificity&#44; PPV&#44; and NPV&#46; These findings were similar to those of previous pediatric studies on other diseases&#46; Moreover&#44; it agrees with previous studies based on an adult population on the usefulness of low-dose CT in making a diagnosis of acute appendicitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">However&#44; due to the retrospective nature of the study&#44; CT was not performed using a certain pre-determined dose&#59; rather&#44; the dose was determined by age and weight&#46; For these reasons&#44; there was no consistency in the tube voltage or current&#46; In particular&#44; the range was relatively wider in the case of standard-dose CT&#46; In addition&#44; the mean age was slightly lower in the low-dose CT group than in the standard-dose CT group&#46; Nonetheless&#44; there was no age-related significant difference between the two CT groups&#46; Furthermore&#44; there was also no significant difference in the number of patients in each group&#46; In addition&#44; the radiation dose was actually lower by approximately 64&#46;2&#37; in the low-dose CT group&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In the current study&#44; of the 614 patients &#40;including those who were excluded due to an undefined radiation dose&#41; in whom USG or CT was performed due to the suspicion of appendicitis&#44; 388 actually had appendicitis and the remaining 226 did not&#46; During the diagnostic procedure&#44; patients presenting with other diseases&#44; based on test results&#44; such as intussusception or malignancy&#44; were initially excluded&#46; In addition&#44; the study also excluded those in which the purpose of radiological evaluation was unclear&#59; therefore&#44; the number of patients in the negative group might be greater&#44; and the actual NPV may also be higher than that found in this study&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">However&#44; the present results do not support the imprudent use of low-dose CT for diagnosing acute appendicitis&#46; According to the National Academy of Science report about health risks from exposure to low levels of ionizing radiation&#44; BEIR VII&#44; there would be a linear increase in the risk of developing cancer even at a low dose&#44; without a specific threshold&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> This should also be accompanied by the definition of a rationale that is appropriate for the age and radiation dose used in each center&#46; In recent years&#44; abdominal USG has been used as the first-line of measure for making a diagnosis of acute appendicitis not only in adults&#44; but also in children&#46; In equivocal cases&#44; a CT is performed&#46; This staging protocol has been studied and reported&#44; and should be applied in a clinical setting&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">18&#44;29</span></a> In these cases&#44; low-dose CT may become an alternative modality to standard-dose CT&#46; Furthermore&#44; in the present study&#44; regarding the cases in which a CT was performed after USG&#44; there were four patients in the low-dose CT group and five patients in the standard-dose CT group&#46; An accurate diagnosis was made at a probability of 100&#37; in all 15 patients&#44; including in the six patients who were excluded from the current analysis&#44; due to a lack of accurate dose data&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">There are several limitations to the present study&#46; The number of patients diagnosed by USG was smaller than the number of patients diagnosed with appendicitis by of low-dose CT&#59; therefore&#44; it was not possible to make a direct comparison between these two options&#46; However&#44; numerous previous studies have investigated diagnosis <span class="elsevierStyleItalic">via</span> USG&#44; which has been found to be greatly dependent on the expertise or subjective judgment of the observer&#46; Moreover&#44; there was no notable difference in the degree of diagnostic accuracy by USG between this and previous studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">30&#44;31</span></a> Therefore&#44; the present results indicate that low-dose CT is not inferior to USG in the diagnosis of appendicitis&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; low-dose CT is effective and relatively accurate for diagnosing acute appendicitis of patients in childhood&#44; as well as in adolescence and young adulthood&#46; Moreover&#44; low-dose CT was highly accurate&#44; regardless of age or BMI&#44; for detecting acute appendicitis&#46; Therefore&#44; low-dose CT may be a superior diagnostic tool when compared with USG&#44; and may be an alternative modality to standard-CT for assessing pediatric patients suspected of having acute appendicitis&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres935725"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objectives"
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            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
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        1 => array:2 [
          "identificador" => "xpalclavsec909671"
          "titulo" => "Keywords"
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          "identificador" => "xres935724"
          "titulo" => "Resumo"
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          "identificador" => "xpalclavsec909672"
          "titulo" => "Palavras-chave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Patients and data extraction"
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            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Diagnostic imaging methods"
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              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
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          "titulo" => "Results"
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          "identificador" => "sec0035"
          "titulo" => "Comparison of the radiation dose parameters between the CT groups"
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          "identificador" => "sec0040"
          "titulo" => "Comparison of the diagnosis of appendicitis based on imaging studies"
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          "identificador" => "sec0045"
          "titulo" => "Comparison of the diagnostic methods based on the age group"
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          "identificador" => "sec0050"
          "titulo" => "A comparison of the diagnostic methods based on BMI"
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          "titulo" => "Discussion"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-07-23"
    "fechaAceptado" => "2017-01-02"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec909671"
          "palabras" => array:4 [
            0 => "Appendicitis"
            1 => "Childhood"
            2 => "Computed tomography"
            3 => "Ultrasonography"
          ]
        ]
      ]
      "pt" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palavras-chave"
          "identificador" => "xpalclavsec909672"
          "palabras" => array:4 [
            0 => "Apendicite"
            1 => "Inf&#226;ncia"
            2 => "Tomografia computadorizada"
            3 => "Ultrassonografia"
          ]
        ]
      ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Computed tomography should be performed after careful consideration due to radiation hazard&#44; which is why interest in low dose CT has increased recently in acute appendicitis&#46; Previous studies have been performed in adult and adolescents populations&#44; but no studies have reported on the efficacy of using low-dose CT in children younger than 10 years&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>475&#41; younger than 10 years who were examined for acute appendicitis were recruited&#46; Subjects were divided into three groups according to the examinations performed&#58; low-dose CT&#44; ultrasonography&#44; and standard-dose CT&#46; Subjects were categorized according to age and body mass index &#40;BMI&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Low-dose CT was a contributive tool in diagnosing appendicitis&#44; and it was an adequate method&#44; when compared with ultrasonography and standard-dose CT in terms of sensitivity &#40;95&#46;5&#37; <span class="elsevierStyleItalic">vs</span>&#46; 95&#46;0&#37; and 94&#46;5&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;794&#41;&#44; specificity &#40;94&#46;9&#37; <span class="elsevierStyleItalic">vs&#46;</span> 80&#46;0&#37; and 98&#46;8&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#41;&#44; positive-predictive value &#40;96&#46;4&#37; <span class="elsevierStyleItalic">vs</span>&#46; 92&#46;7&#37; and 97&#46;2&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;019&#41;&#44; and negative-predictive value &#40;93&#46;7&#37; <span class="elsevierStyleItalic">vs</span>&#46; 85&#46;7&#37; and 91&#46;3&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;890&#41;&#46; Low-dose CT accurately diagnosed patients with a perforated appendix&#46; Acute appendicitis was effectively diagnosed using low-dose CT in both early and middle childhood&#46; BMI did not influence the accuracy of detecting acute appendicitis on low-dose CT&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Low-dose CT is effective and accurate for diagnosing acute appendicitis in childhood&#44; as well as in adolescents and young adults&#46; Additionally&#44; low-dose CT was relatively accurate&#44; irrespective of age or BMI&#44; for detecting acute appendicitis&#46; Therefore&#44; low-dose CT is recommended for assessing children with suspected acute appendicitis&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objectives"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
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            "titulo" => "Conclusion"
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      "pt" => array:3 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A tomografia computadorizada deve ser realizada ap&#243;s cautelosa considera&#231;&#227;o devido ao perigo de radia&#231;&#227;o&#44; motivo pelo qual o interesse na TC de baixa dosagem tem aumentado recentemente em casos de apendicite aguda&#46; Estudos anteriores foram realizados em popula&#231;&#245;es adultas ou adolescentes&#44; por&#233;m nenhum estudo relatou a efic&#225;cia do uso da TC de baixa dosagem em crian&#231;as com menos de 10 anos de idade&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Recrutamos pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>475&#41; com menos de 10 anos de idade examinados com rela&#231;&#227;o a apendicite aguda&#46; Os indiv&#237;duos foram divididos em tr&#234;s grupos de acordo com os exames realizados&#58; TC de baixa dosagem&#44; ultrassonografia e TC de dosagem padr&#227;o&#46; Os indiv&#237;duos foram categorizados de acordo com a idade e o &#237;ndice de massa corporal&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A TC de baixa dosagem foi uma ferramenta de grande contribui&#231;&#227;o no diagn&#243;stico de apendicite e um m&#233;todo adequado em compara&#231;&#227;o &#224; ultrassonografia e &#224; TC de dosagem padr&#227;o em termos de sensibilidade &#40;95&#44;5&#37; em compara&#231;&#227;o a 95&#44;0&#37; e 94&#44;5&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;794&#41;&#44; especificidade &#40;94&#44;9&#37; em compara&#231;&#227;o a 80&#44;0&#37; e 98&#44;8&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#41;&#44; valor preditivo positivo &#40;96&#44;4&#37; em compara&#231;&#227;o a 92&#44;7&#37; e 97&#44;2&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;019&#41; e valor preditivo negativo &#40;93&#44;7&#37; em compara&#231;&#227;o a 85&#44;7&#37; e 91&#44;3&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;890&#41;&#46; A TC de baixa dosagem diagnosticou de forma precisa pacientes com um ap&#234;ndice perfurado&#46; A apendicite aguda foi diagnosticada de maneira efetiva utilizando a TC de baixa dosagem tanto na primeira quanto na segunda inf&#226;ncia&#46; O IMC n&#227;o influenciou a precis&#227;o da detec&#231;&#227;o de apendicite aguda na TC de baixa dosagem&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclus&#227;o</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A TC de baixa dosagem &#233; eficaz e precisa no diagn&#243;stico de apendicite aguda na inf&#226;ncia&#44; bem como em adolescentes e jovens adultos&#46; Al&#233;m disso&#44; a TC de baixa dosagem foi relativamente precisa&#44; independentemente de idade ou IMC&#44; na detec&#231;&#227;o de apendicite aguda&#46; Assim&#44; a TC de baixa dosagem &#233; recomendada na avalia&#231;&#227;o de crian&#231;as com suspeita de apendicite aguda&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivos"
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            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
            "titulo" => "Conclus&#227;o"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Yi DY&#44; Lee KH&#44; Park SB&#44; Kim JT&#44; Lee NM&#44; Kim H&#44; et al&#46; Accuracy of low dose CT in the diagnosis of appendicitis in childhood and comparison with USG and standard dose CT&#46; J Pediatr &#40;Rio J&#41;&#46; 2017&#59;93&#58;625&#8211;31&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CT&#44; computed tomography&#59; USG&#44; ultrasonography&#59; WBC&#44; white blood cell&#59; ANC&#44; absolute neutrophil count&#59; ESR&#44; erythrocyte sedimentation rate&#59; hsCRP&#44; highly sensitive C-reactive protein&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Low-dose CT &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>112&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Abdominal USG &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Standard-dose CT &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>145&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 imaging groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 CT groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mean age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;31<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;85<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#46;94<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;329&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Age group</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Early childhood&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;14&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;32&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;13&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;022<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Middle childhood&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96 &#40;85&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;67&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">125 &#40;86&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Male gender</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;66&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;47&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96 &#40;66&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mean body mass index</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;34<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;000<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Duration of hospital stay &#40;days&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;151&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;061&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">No&#46; of perforation patients</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;17&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;29&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;241&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Laboratory Findings</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WBC &#40;&#47;mm<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;438<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4938&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#44;117<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4670&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;241<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4737&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;026<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;749&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ANC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;654<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4797&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9378<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4519&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;245<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4571&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;029<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;494&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ESR &#40;mm&#47;h&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;660&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;670&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>hsCRP &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>57&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>52&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;031<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;329&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 imaging groups&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#47;40 &#40;95&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137&#47;145 &#40;94&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;794&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;781&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Specificity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">74&#47;78 &#40;94&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#47;15 &#40;80&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#47;85 &#40;98&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;004<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;194&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>PPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107&#47;111 &#40;96&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38&#47;41 &#40;92&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137&#47;138 &#40;97&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;019<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>NPV&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#47;14 &#40;85&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84&#47;92 &#40;91&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;890&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;774&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Diagnosis of perforation</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#47;7 &#40;85&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#47;42 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;027<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CT&#44; computed tomography&#59; USG&#44; ultrasonography&#59; PPV&#44; positive predictive value&#59; NPV&#44; negative predictive value&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Age group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Low-dose CT &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>190&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Abdominal USG &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Standard-dose CT &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>230&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 imaging groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 CT groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="middle">Early childhood &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>107&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#47;16 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;13 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#47;20 &#40;95&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Specificity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#47;28 &#40;96&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;1 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#47;29 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;365&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;491&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#47;17 &#40;94&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#47;13 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#47;19 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;878&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;472&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#47;27 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#47;1 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29&#47;30 &#40;96&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;349&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="middle">Middle childhood &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>368&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#47;96 &#40;94&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#47;27 &#40;92&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&#47;125 &#40;94&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;829&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Specificity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#47;50 &#40;94&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;14 &#40;78&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#47;56 &#40;98&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;011<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;341&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#47;94 &#40;96&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#47;28 &#40;89&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&#47;119 &#40;99&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;009<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;323&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#47;52 &#40;90&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;13 &#40;84&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&#47;62 &#40;88&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;865&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">BMI&#44; body mass index&#59; CT&#44; computed tomography&#59; USG&#44; ultrasonography&#59; PPV&#44; positive predictive value&#59; NPV&#44; negative predictive value&#59; NS&#44; no significant difference&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">BMI group&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Low-dose CT &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>190&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Abdominal USG &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Standard-dose CT &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>230&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 imaging groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2 CT groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="middle">Underweight &#40;&#60;5th percentile&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>46&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;12 &#40;91&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;7 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;7 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Specificity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;10 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;3 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;7 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">PPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#47;11 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;7 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;7 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">NPV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#47;11 &#40;90&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#47;3 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#47;7 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;774&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="7" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="middle">Normal &#40;5th to 85th percentile&#41; &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>339&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Sensitivity&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&#47;89 &#40;95&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#47;27 &#40;92&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#47;96 &#40;94&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;795&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Specificity&nbsp;\t\t\t\t\t\t\n
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