Abdominal screening with ultrasound in children with suspected acute appendicitis

Ultrasound (US) is the first-line modality for the assessment of acute appendicitis (AA) in children. Because alternative diagnoses in these patients are common, some centers have expanded US to include screening of the entire abdomen and pelvis. However, insufficient data prevent consensus on whether this practice improves the detection of abdominal pathologies in the differential diagnosis for AA. To determine whether comprehensive US screening of the abdomen/pelvis improves the detection rate of abdominal pathologies among children presenting with symptoms consistent with AA, and to guide optimization of scanning protocols using historical data.

Children who received comprehensive abdominal screening and with signs and symptoms consistent with AA were retrospectively and consecutively sampled from a tertiary care teaching hospital. US findings were documented and graded for clinical significance by three pediatric radiologists. A one-tailed test of proportions tested the hypothesis that comprehensive abdominal screening meaningfully (5%) increases the proportion of clinically significant screening findings when compared to a focused assessment of the appendix. Optimization modeling was then used to identify the organ systems with the highest diagnostic yield in this context.

Of 202 children (mean age 11.0 ± 4.3) assessed for AA, clinically relevant and urgent incidental findings were found in 30 (15%, p < 0.01). The most clinically relevant findings included ovarian cysts, colitis, and complex fluid collections.

Comprehensive US screening significantly improves the detection of relevant abdominal pathologies in children assessed for AA. Historical data suggest an optimized protocol should include the ovaries, the peritoneum/mesentery, and large and small bowel at minimum.

Question Does comprehensive abdominal and pelvic screening with ultrasound (US) improve the detection of clinically relevant abdominal pathologies in the differential diagnosis for acute appendicitis (AA)? Findings Clinically relevant and urgent incidental findings were found in 30 (15%, p < 0.01) cases, most often within the ovaries, bowel, and peritoneum/mesentery. Clinical relevance This study helps to inform the implementation of screening protocols in children with abdominal pain to improve patient care and clinical efficiency.