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Updated: Jan 20, 2026
Abdominal Exam IV: Acute Abdominal Pain Assessment
Published on: April 30, 2023
Appendicitis or non-specific abdominal pain in pre-school children: When to request abdominal ultrasound?
Marcos Prada-Arias1,2, Javier Gómez-Veiras1, José L Vázquez3
1Department of Pediatric Surgery, University Hospital Álvaro Cunqueiro, Vigo, Spain.
Insights
Diagnosing appendicitis in young children is challenging. C-reactive protein (CRP) and abdominal ultrasound (US) aid in differentiating appendicitis from non-specific abdominal pain (NSAP) when symptoms exceed 12 hours.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Clinical Pathology
Background:
- Differentiating appendicitis from non-specific abdominal pain (NSAP) in pre-school children presents diagnostic challenges.
- Clinical signs and symptoms often lack specificity in this age group.
Purpose of the Study:
- To identify the most effective diagnostic tools for distinguishing appendicitis from NSAP in pre-school children.
- To evaluate the utility of clinical findings, laboratory tests, and imaging in this differentiation.
Main Methods:
- Prospective evaluation of children aged 5 years or younger presenting with suspected appendicitis.
- Statistical analysis and diagnostic accuracy studies were performed on collected variables.
- Inclusion and exclusion criteria were used to categorize patients into NSAP and appendicitis groups.
Main Results:
- No single symptom or sign reliably differentiated appendicitis from NSAP.
- Appendicitis complications increased with symptom duration exceeding 12 hours.
- C-reactive protein (CRP) >34 mg/L showed a strong association with appendicitis (OR 9.8).
- Abdominal ultrasound (US) demonstrated high sensitivity and specificity, particularly when symptom duration was >12 hours.
Conclusions:
- History and physical examination are crucial but often limited in pre-schoolers.
- CRP and abdominal US are valuable investigations for improving diagnostic accuracy.
- Abdominal pain >12 hours or CRP >34 mg/L warrants abdominal US in pre-schoolers with right lower quadrant tenderness.
Aim:
The aim of this study is to determine the most useful diagnostic tools to differentiate appendicitis from non-specific abdominal pain (NSAP) in pre-school children.
Methods:
We prospectively evaluated all children aged 5 years or younger admitted for suspected appendicitis at a paediatric emergency department during 5 years. Cases of NSAP and appendicitis were enrolled according to inclusion and exclusion criteria. The different variables collected were assessed by statistic and diagnostic accuracy studies.
Results:
A total of 82 patients were studied: 27 cases of NSAP and 55 cases of appendicitis. We found no symptoms or signs with a high power of discrimination between both processes. Complicated cases of appendicitis begin to appear when the duration of symptoms exceeds 12 h. Among laboratory tests, C-reactive protein (CRP) value >34 mg/L was the variable with a greater association to appendicitis (odds ratio 9.8). Abdominal ultrasound (US) had high sensitivity and specificity to differentiate appendicitis, significantly improving its diagnostic accuracy when the duration of symptoms exceeds 12 h.
Conclusions:
A good history and physical examination are important in the diagnostic process, but reliable physical signs can be difficult to elicit in pre-school children. CRP and abdominal US are useful investigations that can improve diagnostic accuracy. According to our results, abdominal pain duration longer than 12 h or CRP value >34 mg/L should be an indication to perform an abdominal US in pre-school children with right lower quadrant tenderness.
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