Abstract
Introduction Ultrasound (US) is the preferred imaging modality for evaluating appendicitis. Our purpose was to determine if including secondary signs (SS) improve diagnostic accuracy in equivocal US studies. Methods Retrospective review identified 825 children presenting with concern for appendicitis and with a right lower quadrant (RLQ) US. Regression models identified which SS were associated with appendicitis. Test characteristics were demonstrated. Results 530 patients (64%) had equivocal US reports. Of 114 (22%) patients with equivocal US undergoing CT, those with SS were more likely to have appendicitis (48.6% vs 14.6%, p < 0.001). Of 172 (32%) patients with equivocal US admitted for observation, those with SS were more likely to have appendicitis (61.0% vs 33.6%, p < 0.001). SS associated with appendicitis included fluid collection (adjusted odds ratio (OR) 13.3, 95% confidence interval (CI) 2.1–82.8), hyperemia (OR = 2.0, 95%CI 1.5–95.5), free fluid (OR = 9.8, 95%CI 3.8–25.4), and appendicolith (OR = 7.9, 95%CI 1.7–37.2). Wall thickness, bowel peristalsis, and echogenic fat were not associated with appendicitis. Equivocal US that included hyperemia, a fluid collection, or an appendicolith had 96% specificity and 88% accuracy. Conclusion Use of SS in RLQ US assists in the diagnostic accuracy of appendicitis. SS may guide clinicians and reduce unnecessary CT and admissions.
Original language | English (US) |
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Pages (from-to) | 1655-1660 |
Number of pages | 6 |
Journal | Journal of pediatric surgery |
Volume | 51 |
Issue number | 10 |
DOIs | |
State | Published - Oct 1 2016 |
Funding
This research is supported by the + Children's Pediatric Research Trust, Children's Healthcare of Atlanta, and the Department of Surgery at Emory University. National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR000454 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. In addition, MVR is supported by the Emory
Keywords
- Appendicitis
- Pediatric surgery
- Quality improvement
- Secondary signs
- Ultrasound
ASJC Scopus subject areas
- Surgery
- Pediatrics, Perinatology, and Child Health