APPENDICITIS AND ULTRASOUND

Diagnostic accuracy of serial ultrasounds for pediatric appendicitis (April 2015)

In pediatric patients whose initial ultrasound is equivocal for the diagnosis of appendicitis and who have persistent findings, repeat physical examination and a second ultrasound has good diagnostic accuracy and can markedly reduce the use of computed tomography (CT). A prospective observational study of 294 children undergoing acute evaluation for abdominal pain (38 percent with appendicitis) evaluated a protocol stratifying children into three paths: serial physical examination, surgical consultation, and repeat ultrasound if the initial ultrasound was equivocal; discharge home if the initial ultrasound showed a normal appendix; and surgical consultation if the initial ultrasound was positive for appendicitis [31]. This strategy, consistent with our approach, achieved a sensitivity of 97 percent and a specificity of 91 percent; CT was performed in four patients