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| EVIDENCE-BASED MEDICINE: SUMMARY OF STUDY |
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| Year : 2017 | Volume
: 15
| Issue : 2 | Page : 139-141 |
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Ultrasound abdomen in pediatric appendicitis
Tony Abraham Thomas
Christian Medical College, Vellore, Tamil Nadu, India
| Date of Web Publication | 18-May-2017 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/cmi.cmi_30_17
How to cite this article:
Thomas TA. Ultrasound abdomen in pediatric appendicitis. Curr Med Issues 2017;15:139-41 |
Source: This is a summary of the study: Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP. Radiology. 2017 Mar;282(3):835-841. Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort. Summary prepared by Dr. Tony Abraham Thomas, Christian Medical College, Vellore, Tamil Nadu, India.
Clinical Question: Is ultrasound useful in differentiating between perforated and nonperforated appendicitis in children?
Authors' conclusions: (1) Ultrasound is highly specific but has a poor sensitivity for diagnosis of perforated pediatric appendicitis. (2) There are certain clinical and ultrasound characteristics that are positively associated with perforated appendicitis - - long duration of symptoms, increased width of the appendix, fluid within the lumen, and periappendiceal fluid and appendicolith.
| Background | |  |
Ultrasound plays an important role in the diagnosis of appendicitis in children, in conjunction with clinical history, examination findings, and laboratory investigations (elevated total leukocyte count, total neutrophil count, and C-reactive protein). Ultrasound is the preferred diagnostic modality because it is cheap, noninvasive, involves no ionizing radiation, and the scan can be performed quickly at the bedside. The diagnostic accuracy of ultrasound in diagnosing appendicitis is also well established. However, the question whether it be can be used to differentiate between nonperforated from perforated appendicitis has not been fully resolved. This is important because, in recent times, the interest in nonsurgical treatment of nonperforated appendicitis has increased. The diagnostic accuracy of ultrasound in differentiating between perforated and nonperforated appendicitis in literature has been poor, with a sensitivity of <50% (specificity >90%) and there have been no prospective studies in this regard.
Study methodology
The authors of this study [1] prospectively followed up nearly 600 children with suspected appendicitis who underwent ultrasound from July 1, 2013, to July 9, 2014 [Table 1]. According to their institutional protocol, grayscale and color Doppler imaging of the right lower quadrant was performed using a graded compression technique. The ultrasound studies were interpreted using a structured reporting template and a risk-stratified scoring system. This appendicitis scoring system (which was described in an earlier publication [2]) designated those with a score of 5a as having nonperforated and those with a score of 5b as having perforated appendicitis [Table 2]. Surgical diagnosis was used as the reference standard for the diagnosis.
| Results | | |
- Ultrasound identified appendicitis correctly in 573 out of 577 (99.3%) of cases, with a false-positive rate of 0.7% (four of 577 cases)
- The accuracy of ultrasound in diagnosing perforated appendicitis [Table 3]:
 | Table 3: Diagnostic accuracy of ultrasound in differentiating between perforated and nonperforated ultrasound
Click here to view |
- Sensitivity – 44% (80 of 182 cases)
- Specificity – 93.1% (364 of 391 cases)
- Positive predictive value – 74.8% (80 of 107 cases)
- Negative predictive value – 78.1% (364 of 466 cases).
- Even though the diagnostic performance was poor in differentiating between perforated and nonperforated appendicitis, multivariate analysis showed that there were certain ultrasound features that are suggestive of perforated appendicitis [Table 4].
 | Table 4: Clinical and ultrasound features that are positively associated with perforated appendicitis
Click here to view |
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Carpenter JL, Orth RC, Zhang W, Lopez ME, Mangona KL, Guillerman RP. Diagnostic performance of US for differentiating perforated from nonperforated pediatric appendicitis: A prospective cohort study. Radiology 2017;282:835-41.  [ PUBMED] |
| 2. | Fallon SC, Orth RC, Guillerman RP, Munden MM, Zhang W, Elder SC, et al. Development and validation of an ultrasound scoring system for children with suspected acute appendicitis. Pediatr Radiol 2015;45:1945-52. [ PUBMED] |
[Table 1], [Table 2], [Table 3], [Table 4]
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