To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard

Ann Med Surg (Lond). 2018 Dec 18;38:22-27. doi: 10.1016/j.amsu.2018.11.019. eCollection 2019 Feb.


Background: To determined the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard.

Methods: A prospective evaluations of all ultrasound for appendicitis from January 1, 2014, to June 15, 2017, was conducted at our hospital. A diagnostic protocol was implemented to reduce radiation exposure employing US as the initial imaging modality followed by CT for non-diagnostic US studies in patients with an equivocal clinical presentation. The imaging, operative findings, and pathology of 223 patients (females 80, males 143, age less than 14years) with diagnosed appendicitis were collected. The sensitivity, specificity, predictive value, and negative appendectomy rate were also analyzed. All those patients which had subjected to surgery were included to evaluate the true result of ultrasound in diagnosis of appendicitis.

Results: Of the 223 pediatric appendectomies performed in this time period, a total of 192 (86%) were diagnosed by ultrasound. The histopathology of 8 was normal (3.6%), CT done in 11 and three was normal. The negative appendectomy rate was 3.6%. US were the sole imaging modality in all patients.

Conclusions: In the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure.

Study design: cross sectional validation.

Keywords: Acute appendicitis; Histopathology; Ultrasound.