Pediatric appendiceal ultrasound: accuracy, determinacy and clinical outcomes

Abstract

US should be the initial imaging study of choice for pediatric appendicitis. When a definitive interpretation was given, the accuracy was 96%, was independent of patient and system factors and resulted in reduced follow-up CTs and negative laparotomies. Accuracy can be increased by requiring the presence of periappendiceal inflammatory changes prior to interpreting a mildly distended appendix as positive for acute appendicitis. The indeterminate study rate can be reduced by not requiring visualization of the normal appendix for the exclusion of acute appendicitis.

Appendiceal ultrasound: the importance of conveying probability of disease

“…This is very much the case in acute appendicitis where history, physical exam, and laboratory and imaging data all contribute to the diagnosis and possible management strategies include further imaging, nonintervention, antibiotic therapy, immediate surgery and delayed surgery. Data from the current study by Binkovitz et al [1] and from our prior study [2] demonstrate the value of information that is available in equivocal ultrasound results. In both studies, the likelihood of appendicitis in a sonographically equivocal case (12.9-24.3% in Binkovitz et al [1], 25.8-39.3% in Larson et al [2]) is distinctly different from the likelihood in a clearly positive (86.5% in Binkovitz et al [1], 92.6% in Larson et al [2]) or negative case (2% in Binkovitz et al [1], 2.6% in Larson et al [2]).…”

“…We were pleased to see the article "Pediatric Appendiceal Ultrasound: Accuracy, Determinacy and Clinical Outcomes" by Dr. Binkovitz and colleagues [1] in which the authors describe a six-category interpretive scheme for ultrasound of the appendix. The scheme that they describe is very similar to a five-category scheme that we recently published [2].…”

Appendiceal ultrasound: the importance of determinacy

“…Nielsen et al [5] have found that the introduction of a US reporting scheme that did not include indeterminate categories decreased both the rate of follow-up CT studies and negative laparotomies while increasing US sensitivity and accuracy [5]. The results from our study identified ways to increase determinacy and accuracy [2] and we have begun to implement these changes while monitoring for negative outcomes.…”

“…Trout and Larson [1] concerning our article in this issue of Pediatric Radiology and the opportunity to further this discussion with a few additional thoughts. There are striking similarities between our two studies with respect to design and results but there are substantial differences in the conclusions drawn [2,3].…”

“…Trout and Larson [1] concerning our article in this issue of Pediatric Radiology and the opportunity to further this discussion with a few additional thoughts. There are striking similarities between our two studies with respect to design and results but there are substantial differences in the conclusions drawn [2,3].Patients referred for US evaluation for acute appendicitis have already been stratified into an indeterminate risk group based on their clinical data. Those thought to have a very high probability of acute appendicitis may be sent directly to surgery and those thought to have a very low probability of appendicitis often are not imaged at all.…”