Outcomes for Children With a Nonvisualized Appendix on Ultrasound

Area of Science:

• Pediatric Emergency Medicine
• Diagnostic Imaging

Background:

• Ultrasound is a common diagnostic tool for appendicitis.
• In some cases, the appendix is not visualized on ultrasound, necessitating further evaluation.

Purpose of the Study:

• To determine the rate of appendicitis when the appendix is not visualized on ultrasound in children.
• To identify clinical predictors of appendicitis in this patient group.

Main Methods:

• Retrospective chart review of pediatric patients undergoing abdominal ultrasound.
• Analysis of ultrasounds with nonvisualized appendix and subsequent follow-up.
• Logistic regression used to assess predictive value of clinical factors.

Main Results:

• The appendix was not visualized in 54% of 3245 ultrasounds.
• Appendicitis was diagnosed in 11.9% of patients with a nonvisualized appendix.
• Male sex, leukocytosis, and elevated absolute neutrophil count were significant predictors of appendicitis.

Conclusions:

• A substantial number of children with suspected appendicitis have a nonvisualized appendix on initial ultrasound.
• Clinical factors are important in diagnosing appendicitis when ultrasound is inconclusive.
• Continued vigilance and diagnostic pursuit are crucial for non-diagnostic ultrasounds.