Does early ultrasonography affect management of pediatric appendicitis? A prospective analysis

Background: Appendicitis remains a difficult diagnosis in children. Ultraso nography is increasingly used for the diagnosis of appendicitis, although t he proper clinical role for this test remains unclear. Methods: To evaluate the clinical utility of ultrasonography in appendiciti s, the authors analyzed prospectively all children evaluated for possible a ppendicitis from January 1 through December 31, 1997. Children with a high clinical suspicion of appendicitis were referred for surgery (n = 122). Chi ldren with equivocal findings of appendicitis were referred for early ultra sonography (EUS) and formed the study cohort(n = 103). An initial managemen t plan was made to operate or observe each patient, and a risk of appendici tis (doubtful, possible, probable) was assigned by a pediatric surgery fell ow. EUS was then performed, and its effect on management was assessed. Results: Using clinical judgment to operate at initial presentation, the se nsitivity was 38% and specificity was 95%. Using EUS alone, the sensitivity was 87% and specificity was 88%. The management of 30 of 103 patients (30% ) was changed after EUS, including a decision to operate in 28 patients and a decision not to operate in two patients. Conclusions: EUS appears to have substantial clinical utility in children w ith equivocal findings of appendicitis, and its use complements the clinica l management. The use of EUS can improve patient care and reduce hospital r esource utilization. Copyright (C) 1999 by W.B. Saunders Company.