Pediatric appendicitis: efficacy of laboratory and radiologic evaluation

We retrospectively reviewed 54 consecutive children (mean age, 12 years) evaluated for possible appendicitis to determine the efficacy of laboratory and radiologic procedures in establishing the diagnosis. The final diagnosis was appendicitis in 24 and abdominal pain not necessitating operation in the remaining 30. Two hundred two laboratory tests were obtained (average 3.7 tests per patient). The mean white blood cell count on initial CBC was 13,930/cu mm overall with a higher mean in the appendicitis group (16,704 vs 11,057/cu mm). Of the 148 tests besides CBC, only 12 (8%) yielded abnormal results; all of these were present on urinalysis and were nondiagnostic. A total of 117 roentgenograms were obtained on initial evaluation (average 2.2 x-ray films per patient). Films were considered abnormal by the ordering physician in 12 cases (24%). When reviewed by the radiologist, 17 abnormalities (33%) were detected. In only seven instances was there agreement in interpretation of abnormality between the ordering physician and the radiologist. This review indicates little usefulness of nonspecific laboratory and radiologic evaluation of possible appendicitis in children. Appendicitis remains a diagnosis of physical examination, and early referral with thorough evaluation by an experienced examiner may result not only in improved accuracy, but in less delay in appropriate therapy, with greater cost effectiveness.