Evaluation of acute appendicitis by pediatric emergency physician sonography

Ann Emerg Med. 2014 Oct;64(4):358-364.e4. doi: 10.1016/j.annemergmed.2014.03.028. Epub 2014 May 29.


Study objective: We investigate the accuracy of pediatric emergency physician sonography for acute appendicitis in children.

Methods: We prospectively enrolled children requiring surgical or radiology consultation for suspected acute appendicitis at an urban pediatric emergency department. Pediatric emergency physicians performed focused right lower-quadrant sonography after didactics and hands-on training with a structured scanning algorithm, including the graded-compression technique. We compared their sonographic interpretations with clinical and radiologic findings, as well as clinical outcomes as defined by follow-up or pathologic findings.

Results: Thirteen pediatric emergency medicine sonographers performed 264 ultrasonographic studies, including 85 (32%) in children with pathology-verified appendicitis. Bedside sonography had a sensitivity of 85% (95% confidence interval [CI] 75% to 95%), specificity of 93% (95% CI 85% to 100%), positive likelihood ratio of 11.7 (95% CI 6.9 to 20), and negative likelihood ratio of 0.17 (95% CI 0.1 to 0.28).

Conclusion: With focused ultrasonographic training, pediatric emergency physicians can diagnose acute appendicitis with substantial accuracy.

MeSH terms

  • Adolescent
  • Appendicitis / diagnostic imaging*
  • Child
  • Clinical Competence*
  • Emergency Medicine* / education
  • Female
  • Humans
  • Male
  • Pediatrics* / education
  • Point-of-Care Systems*
  • Prospective Studies
  • Radiology
  • Sensitivity and Specificity
  • Ultrasonography