Graded compression ultrasonography in the assessment of the "tough decision" acute abdomen in childhood

The diagnosis of acute appendicitis in childhood is frequently difficult. I n some situations the need to operate is clear, but in others the decisions may be much "tougher" because the clinical findings are equivocal. This is a retrospective study of a consecutive series of 253 children presenting w ith "acute abdominal pain? appendicitis" who had graded compression ultraso nography (GCUS) because the clinical scenario did not warrant immediate lap arotomy. This represents 30% of all cases seen in the study period. The aim of the study was to examine the role of GCUS and a clinical scoring system (the Alvarado score) in patients in whom the diagnosis is uncertain.