Ultrasound for Appendicitis: Performance and Integration with Clinical Parameters

Area of Science:

• Pediatric Surgery
• Diagnostic Imaging
• Emergency Medicine

Background:

• Accurate diagnosis of appendicitis in children is crucial for timely surgical intervention.
• Ultrasound (US) is a common imaging modality for suspected appendicitis in pediatric patients.
• Integrating clinical scores and laboratory markers with imaging may improve diagnostic performance.

Purpose of the Study:

• To assess the diagnostic performance of ultrasound (US) for pediatric appendicitis.
• To evaluate the combined utility of US with the pediatric appendicitis score (PAS) and C-reactive protein (CRP).

Main Methods:

• Retrospective analysis of 438 children with suspected appendicitis undergoing abdominal US.
• US results were dichotomized; a nonvisualized appendix was considered negative.
• Comparison of pediatric vs. general radiologists' performance; analysis of combined US, PAS, and CRP.

Main Results:

• US demonstrated high diagnostic accuracy (Sensitivity 82%, Specificity 97%, PPV 92%, NPV 93%) regardless of age or gender.
• Pediatric radiologists showed significantly higher sensitivity (88%) than general radiologists (71%).
• Combining negative US, PAS < 5, and CRP < 5 mg/L yielded high sensitivity (98%) and NPV (98%).

Conclusions:

• Ultrasound is a valuable and recommended first-line imaging tool for pediatric appendicitis.
• The combination of US, PAS, and CRP can significantly improve diagnostic certainty.
• This integrated approach may help reduce unnecessary hospital admissions and observations.