Clinical versus sonographic evaluation of acute appendicitis in children: A comparison of patient characteristics and outcomes

Purpose: Abdominal sonography has gained popularity in establishing the dia gnosis of appendicitis in children with equivocal clinical presentations. H owever, no clear outcome benefits have been demonstrated to date. The autho rs conducted a retrospective study to compare the characteristics and outco mes of patients undergoing appendectomy after clinical evaluation only with those undergoing the procedure after sonography. Methods: The charts of 454 consecutive patients undergoing appendectomy for acute appendicitis between January 1, 1998 and December 4, 1999 were revie wed. Patients operated on after clinical evaluation only were compared with patients operated on after abdominal sonography. Results: Forty-two percent of patients (n = 191) constituted the sonography group. When compared with the clinical group, these patients had higher pr evalence of female gender (52% v 38%; P = .004), longer symptom duration (2 .2 +/- 2.5 v 1.6 +/- 1.6 days; P =.003), higher incidence of preoperative i n-patient observation (19% v 4%; P < .001), longer duration between evaluat ion and operation (8.0 +/- 3.9 v 4.9 +/- 2.9 hours; P < .001), higher incid ence of normal appendices on pathologic examination (13% v 6%; P = .006), a nd higher incidence of postoperative abscesses or phlegmons (4.4% v 1.2%; P = .04). The groups did not differ significantly in age, hospital stay, inc idence of complicated appendicitis, or incidence of wound infection. Conclusions: Patients undergoing sonography before appendectomy have a long er delay before operation, a higher rate of misdiagnosis, and more postoper ative complications. Limiting sonography to truly equivocal cases and using it early in the diagnostic workup may improve outcomes in this group of pa tients. J Pediatr Surg 36:780-783. Copyright (C) 2001 by W.B. Saunders Comp any.