Evaluating the diagnostic accuracy of point-of-care ultrasound for paediatric appendicitis: a UK multicentre observational study

Abstract

Objective: To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) performed by paediatric emergency medicine (PEM) clinicians for suspected paediatric appendicitis.

Design: Prospective observational study.

Setting: Two paediatric emergency departments in the UK.

Patients: Patients aged 1-16 years presenting with abdominal pain and right lower quadrant tenderness on examination.

Primary outcome measures: Sensitivity, specificity, positive predictive value and negative predictive value of POCUS.

Secondary outcome measure: Comparison to radiology-performed ultrasound in terms of agreement of findings.

Results: 226 patients were included in our study, of which 130 (58%) were boys. The mean age of patients was 9.7 years. 28 patients had appendicitis confirmed on histological examination, giving a prevalence of 12.4%. Compared with our reference standard, POCUS demonstrated a sensitivity of 0.89 (0.71-0.97), specificity 0.96 (0.92-0.98) positive predictive value 0.76 (0.57-0.88) and negative predictive value 0.98 (0.95-1.00). The appendix was visualised in 82/226 patients (36%). There was a very high degree of agreement between POCUS and radiology-performed ultrasound with a Cohen's kappa (k) of 0.87 (95% CI 0.70 to 1.00).

Conclusion: POCUS performed by PEM clinicians has a high degree of accuracy in detecting paediatric appendicitis. There was a high level of agreement between POCUS and radiology-performed ultrasound.

Keywords: Paediatric Emergency Medicine; Paediatrics.