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Routine ultrasound for suspected appendicitis in children: a single-centre retrospective cohort study
A R Darbyshire1, A Towers1, R Harrison1
1Portsmouth Hospitals University NHS Trust, UK.
Insights
Routine ultrasound effectively diagnoses appendicitis in children, significantly reducing unnecessary surgeries. This imaging approach offers high accuracy and a low negative appendicectomy rate, improving pediatric surgical care.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Appendicitis is a common pediatric surgical emergency with diagnostic challenges.
- Diagnostic imaging, particularly ultrasound, is increasingly used to improve accuracy and reduce negative appendicectomy rates.
- This study evaluates the implementation of routine ultrasound for suspected appendicitis in children.
Purpose of the Study:
- To assess the effectiveness of routine ultrasound in diagnosing appendicitis in children.
- To determine the accuracy (sensitivity and specificity) of ultrasound for appendicitis.
- To evaluate the impact of routine ultrasound on negative appendicectomy rates and patient outcomes.
Main Methods:
- A retrospective cohort study of children aged 5-16 years with suspected appendicitis.
- Data collected on ultrasound use, diagnostic accuracy, negative appendicectomy rate, treatment, length of stay, and complications.
- Analysis of outcomes over a 12-month period.
Main Results:
- Ultrasound was used in 87.5% of 193 children with suspected appendicitis.
- Ultrasound demonstrated high sensitivity (90%) and specificity (100%) for diagnosing appendicitis.
- The negative appendicectomy rate was very low at 1.4%, with laparoscopic appendicectomy being the primary surgical approach.
Conclusions:
- Routine ultrasound is a highly sensitive and specific tool for diagnosing appendicitis in children.
- Implementing routine ultrasound significantly lowers the negative appendicectomy rate.
- This practice change represents a major advancement for pediatric surgical units.
Introduction:
Appendicitis continues to be a common surgical emergency in children, but its diagnosis remains challenging. Use of diagnostic imaging to confirm appendicitis has gained popularity in some countries because it is associated with lower negative appendicectomy rates. This study reports our centre's experience of adopting routine ultrasound for the investigation of suspected appendicitis in children.
Methods:
A single-centre retrospective cohort study was performed investigating all children aged 5-16 years admitted under surgeons with suspected appendicitis, in January-December 2019. Primary outcomes were the rate of ultrasound use, its accuracy in diagnosing/excluding appendicitis and negative appendicectomy rate. Other outcomes were treatment received, length of stay and complications.
Results:
The majority of the 193 children with suspected appendicitis underwent a diagnostic ultrasound (87.5%). Ultrasound was highly sensitive (0.90, 95% confidence interval (CI) 0.81-0.96) and specific (1.0, 95% CI 0.96-1.0) for appendicitis in this study. Negative appendicectomy rate was extremely low (1.4%). Laparoscopic appendicectomy was the preferred management (75/86), with one case started open and no conversions to open. A minority of cases of simple appendicitis (10/86) were treated primarily with antibiotics. Rates of complex appendicitis and postoperative complications were similar to other studies.
Conclusion:
Ultrasound can be highly sensitive and specific for appendicitis. Its routine use to confirm appendicitis prior to surgery is associated with a low negative appendicectomy rate. This is a major change in practice for a general surgical unit in the United Kingdom.
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