Related Experiment Video
Updated: May 1, 2026
Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography
Published on: June 21, 2024
Is pelvic ultrasound associated with an increased time to appendectomy in pediatric appendicitis?
Naveen Poonai1, Jonathan Gregory1, Graham Thompson2
1Western University, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.
Insights
Pelvic ultrasound (US) in children with appendicitis may delay surgery. Female patients and those seen after hours experienced longer wait times for appendectomy when US was used.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Appendicitis is a frequent pediatric surgical emergency.
- Pelvic ultrasound (US) is a common diagnostic tool for pediatric appendicitis.
- Concerns exist regarding potential delays in definitive treatment associated with US.
Purpose of the Study:
- To evaluate if pelvic ultrasound (US) is linked to increased time to appendectomy in pediatric acute appendicitis cases.
- To test the hypothesis that US use delays surgical intervention for appendicitis in children.
Main Methods:
- Retrospective chart review of pediatric patients (0-17 years) diagnosed with appendicitis.
- Comparison of time from initial evaluation to appendectomy between patients who received US and those who did not.
- Analysis of factors influencing time to surgery, including patient demographics and time of presentation.
Main Results:
- 662 pediatric appendicitis cases were analyzed; 424 (64%) underwent pelvic US.
- Median time to appendectomy was significantly longer for patients receiving US (9.7 hours) versus those without US (5.5 hours).
- Increased time to surgery was associated with female sex and after-hours presentation among US patients.
Conclusions:
- Pelvic ultrasound use in pediatric appendicitis is associated with a significant delay in appendectomy.
- Female pediatric patients and those presenting after hours are particularly affected by these delays when US is employed.
- Findings suggest a need to optimize diagnostic pathways to minimize treatment delays in pediatric appendicitis.
Background:
Appendicitis is a common pediatric condition requiring urgent surgical intervention to prevent complications. Pelvic ultrasound (US) as a diagnostic aid has become increasingly common. Despite its advantages, evidence suggests US can lead to delayed definitive management.
Objective:
The objective was to test the hypothesis that US is associated with an increased time to appendectomy in children with acute appendicitis.
Methods:
A chart review was conducted of all children aged 0-17 years who presented to the pediatric emergency department (ED) with a discharge diagnosis of appendicitis. The primary outcome variable was the interval between initial evaluation to appendectomy between patients who received an US and those who did not.
Results:
Of 662 cases included, 424 patients (64%) underwent a pelvic US and 238 patients underwent an appendectomy without US. Median time interval from initial evaluation in the ED by a physician to appendectomy among patients who received an US was 9.7 h (interquartile range [IQR]: 6.8-15.0 h) compared with 5.5 h (IQR: 3.8-8.6 h) among patients who did not receive an US (Mann-Whitney, p < 0.001). The increased time to appendectomy in patients who received an US was dependent on the patient being female and presenting to the ED after hours (univariate analysis of variance test for interaction, p < 0.05).
Conclusions:
Female pediatric patients and those presenting after hours that undergo an US have a significantly increased time to appendectomy compared with those who do not undergo diagnostic imaging.
More Related Videos
Related Concept Videos
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:19Appendicitis
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...
01:24Imaging Studies II: Ultrasonography
01:20Ultrasound I: Abdominal Ultrasonography
Abdominal ultrasonography, commonly known as abdominal ultrasound, is a vital, non-invasive medical imaging technique widely used in healthcare.
Procedure:
This diagnostic tool allows the clinician to visually inspect internal structures within the abdomen, including vital organs such as the liver, gallbladder, pancreas, kidneys, and spleen.
The abdominal ultrasound process begins with applying a special gel to the patient's skin over the abdomen. This gel enhances the...
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography