Ultrasonographic classification for predicting conservative treatment success in children with non-perforated...

Objective criteria for predicting successful conservative management of pediatric non-perforated appendicitis (NPA) remain elusive. We examined whether ultrasonographic (US) grading can predict treatment outcomes.

We retrospectively analyzed patients aged <16 years who were diagnosed with NPA at a single tertiary pediatric referral center between January 2014 and December 2023. All patients initially received conservative management according to the institutional policy. Emergency surgery was conducted only when clinical symptoms failed to improve or when US findings suggested disease progression. Patients were classified into four US grades (I, IIa, IIb, and III) according to the appendiceal wall integrity and perfusion on power Doppler ultrasonography. The primary outcomes were the success of conservative management (discharge without surgery) and length of hospital stay. Multivariable regression analysis identified factors linked to hospitalization duration.

In total, 247 patients were included. The overall success rate of the conservative management was 95.5%, and those for grades I, IIa, IIb, and III were 100%, 98.8%, 93.4%, and 84.2%, respectively. The median hospital stay increased with the grade (0, 3, 4.5, and 9 days). In the multivariable analysis, the US grade was independently linked to the hospital stay. Compared with Grade I, the ratios were 1.50 (IIa), 2.36 (IIb), and 3.44 (III). Furthermore, appendiceal diameter was correlated with a longer stay.

In this single-center retrospective cohort, US grading may help stratify short-term outcomes of conservative management and length of hospital stay in NPA. Our results suggest that conservative management may be acceptable for Grade IIb, whereas earlier surgery may warrant consideration for Grade III.