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Value of Focused Appendicitis Ultrasound and Alvarado Score in Predicting Appendicitis in Children: Can We Reduce the
Netta M Blitman1, Muhammad Anwar, KeriAnne B Brady
11 Department of Radiology, Jacobi Medical Center, Albert Einstein College of Medicine, 1400 Pelham Pkwy S, Bronx, NY 10461.
Insights
Focused appendicitis ultrasound combined with the Alvarado score accurately identifies appendicitis in children. This approach safely reduces the need for unnecessary CT scans and radiation exposure in pediatric patients.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Surgical Evaluation
Background:
- Appendicitis is a common surgical emergency in children.
- Computed tomography (CT) is frequently used for diagnosis but involves radiation exposure.
- Developing accurate, non-invasive diagnostic methods is crucial.
Purpose of the Study:
- To assess the effectiveness of focused appendicitis ultrasound (FAUS) combined with the Alvarado score in diagnosing appendicitis in children.
- To determine if this combined approach can reduce unnecessary CT examinations.
Main Methods:
- Retrospective analysis of 522 children with suspected appendicitis who underwent FAUS.
- Clinical, laboratory, and imaging findings were reviewed.
- Alvarado score was calculated and compared with FAUS results, surgical outcomes, and pathology reports.
Main Results:
- FAUS provided conclusive results in 25.2% of cases.
- In children with inconclusive FAUS findings, a low Alvarado score (<5) combined with inconclusive ultrasound had a 99.6% negative predictive value (NPV) for appendicitis.
- This combination allowed for safe avoidance of CT in many cases.
Conclusions:
- Inconclusive FAUS findings coupled with a low Alvarado score indicate a very low probability of appendicitis in children.
- This combined diagnostic strategy is safe and effective for reducing unnecessary CT utilization and radiation exposure in pediatric appendicitis evaluation.
Objective:
The purpose of this study was to evaluate the effectiveness of focused appendicitis ultrasound combined with Alvarado score to accurately identify appendicitis in children in whom it is suspected, thereby reducing unnecessary CT examinations and associated radiation exposure.
Materials And Methods:
We retrospectively evaluated the focused appendicitis ultrasound, CT, clinical, and laboratory findings of 522 consecutively registered children (231 boys, 291 girls; mean age, 13.04 [SD, 5.02] years; range, 0.74 months-21 years) who underwent focused appendicitis ultrasound for abdominal pain in a pediatric emergency department from January 2008 through October 2009. All children underwent surgery or clinical follow-up to exclude missed appendicitis. Sonographic findings were characterized as positive, negative, or inconclusive (appendix not visualized). Alternative diagnoses were noted. Alvarado score (0-10 points based on multiple clinical criteria) was determined. Focused appendicitis ultrasound and Alvarado score results were compared with surgical and pathologic reports.
Results:
Both focused appendicitis ultrasound results and Alvarado score were associated with likelihood of surgery for appendicitis (p = 0.0001). Focused appendicitis ultrasound had conclusive results: 105 positive and 27 negative in 132 of 522 (25.2%) children. In the 390 of 522 (74.7%) children with inconclusive focused appendicitis ultrasound findings, 43 of 390 (11.0%) eventually had a diagnosis of appendicitis with CT (n = 26) or Alvarado score (n = 17). Among children with inconclusive focused appendicitis ultrasound findings and an Alvarado score less than 5 (241/522, 46.1%), only one patient had appendicitis. The negative predictive value (NPV) of inconclusive ultrasound findings and low Alvarado score combined was 99.6%. Among children with inconclusive focused appendicitis ultrasound findings and an Alvarado score of 5-8, the NPV decreased to 89.7%.
Conclusion:
Children with inconclusive focused appendicitis ultrasound findings and a low Alvarado score are extremely unlikely to have appendicitis (NPV, 99.6%). Avoiding unnecessary CT of these patients is a safe approach to diagnosis.
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