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Ultrasound for Appendicitis: Performance and Integration with Clinical Parameters
Fanny Löfvenberg1, Martin Salö1
1Department of Clinical Sciences, Pediatrics, and Department of Pediatric Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
Insights
Ultrasound (US) is effective for diagnosing pediatric appendicitis in children. Combining US with the pediatric appendicitis score (PAS) and C-reactive protein (CRP) further enhances diagnostic accuracy, reducing unnecessary hospital admissions.
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.
Abstract:
Objective. To evaluate the performance of ultrasound in pediatric appendicitis and the integration of US with the pediatric appendicitis score (PAS) and C-reactive protein (CRP). Method. An institution-based, retrospective study of children who underwent abdominal US for suspected appendicitis between 2012 and 2015 at a tertiary pediatric surgery center. US results were dichotomized, with a nonvisualized appendix considered as a negative examination. Results. In total, 438 children were included (mean 8.5 years, 54% boys), with an appendicitis rate of 29%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US were 82%, 97%, 92%, and 93%, respectively, without significant age or gender differences. Pediatric radiologists had significantly higher sensitivity compared to general radiologists, 88% and 71%, respectively (p < 0.01), but no differences were seen for specificity, PPV, and NPV. The sensitivity, NPV, and negative likelihood ratio for the combination of negative US, PAS < 5, and CRP < 5 mg/L were 98%, 98%, and 0.05 (95% CI 0.03-0.15). Conclusion. US may be a useful tool for evaluating children with suspected appendicitis, regardless of age or gender, and should be the first choice of imaging modalities. Combining US with PAS and CRP may reduce several unnecessary admissions for in-hospital observation.
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