The impact of ultrasound examinations on the management of children with suspected appendicitis: A 3-year analysis

Background/Purpose: The aim of this study was to evaluate the usefulness of ultrasonography in the routine management of children with suspected appen dicitis in a children's hospital. Methods: Data from surgical, radiologic, and pathologic databases were cros s referenced retrospectively to allow for review of all children undergoing appendectomy and all children undergoing an ultrasound scan to rule out ap pendicitis in the 3-year period August 1, 1996 to July 31, 1999. Results: Pathology reports were available for 1,007 of 1,032 patients under going appendectomy. Eighty-four percent had acute appendicitis (26% of thes e were perforated). Fifty-eight percent of all children undergoing appendec tomy had at least 1 preoperative ultrasound scan. Eighty-six percent of tho se having ultrasound scans had acute appendicitis compared with 82% of thos e who did not have an ultrasound scan (P < .05 <chi>(2) Test). During the s ame period, 2,056 ultrasound examinations were performed by staff radiologi sts who were available 24 hours a day to rule out appendicitis. Ultrasonogr aphy in this setting had a sensitivity of 89%, specificity of 95%, positive predictive value of 86%, and a negative predictive value of 96% (true-posi tives, n = 496; false-positive, n = 81; true-negative, n = 1,417; false-neg ative, n = 62). An alternate ultrasound diagnosis was offered in 157 childr en. Conclusions: Ultrasound scan improves diagnostic accuracy in children with suspected appendicitis. The high negative predictive value of ultrasound sc an, especially when used repeatedly, may reduce the need for admission to h ospital for clinical observation to rule out appendicitis. Copyright (C) 20 01 by W.B. Saunders Company.