Bedside Sonography Performed by Emergency Physicians to Detect Appendicitis in Children

Area of Science:

• Pediatric Emergency Medicine
• Diagnostic Imaging
• Ultrasound Technology

Background:

• Appendicitis is a common surgical emergency in children presenting with acute abdominal pain.
• Point-of-care ultrasound (POCUS) is increasingly used in emergency departments for rapid diagnosis.
• The diagnostic accuracy of POCUS for appendicitis in pediatric populations by emergency physicians requires further evaluation.

Purpose of the Study:

• To assess the diagnostic performance of POCUS in identifying appendicitis in children.
• To evaluate the ability of emergency physicians with varying POCUS experience to detect pediatric appendicitis.

Main Methods:

• Prospective cohort study in a pediatric emergency department.
• 117 children (2-18 years) with suspected appendicitis underwent POCUS by emergency physicians.
• Physicians had basic to experienced levels of POCUS training; all received specific appendix ultrasound training.
• POCUS results (positive, negative, inconclusive) were compared with final diagnoses (pathology/operative reports or follow-up).

Main Results:

• Of 117 patients, 51 had appendicitis.
• POCUS sensitivity for appendicitis was 0.53 (95% CI: 0.40-0.66).
• POCUS specificity was 0.82 (95% CI: 0.71-0.89).
• A high proportion of examinations (69/117) were inconclusive.

Conclusions:

• POCUS demonstrates limited sensitivity and specificity for diagnosing appendicitis in children when performed by emergency physicians with varied experience.
• The high rate of inconclusive POCUS examinations highlights challenges in its application for pediatric appendicitis.
• Further research is needed to improve POCUS utility in this clinical setting.