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Ann Emerg Med. 2014 Oct;64(4):358-364.e4. doi: 10.1016/j.annemergmed.2014.03.028. Epub 2014 May 29.

Evaluation of acute appendicitis by pediatric emergency physician sonography.

Author information

1
Department of Emergency Medicine, Newark Beth Israel Medical Center, Children's Hospital of New Jersey, Newark, NJ. Electronic address: asivitz@barnabashealth.org.
2
Department of Pediatric Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
3
Department of Emergency Medicine, Newark Beth Israel Medical Center, Children's Hospital of New Jersey, Newark, NJ.

Abstract

STUDY OBJECTIVE:

We investigate the accuracy of pediatric emergency physician sonography for acute appendicitis in children.

METHODS:

We prospectively enrolled children requiring surgical or radiology consultation for suspected acute appendicitis at an urban pediatric emergency department. Pediatric emergency physicians performed focused right lower-quadrant sonography after didactics and hands-on training with a structured scanning algorithm, including the graded-compression technique. We compared their sonographic interpretations with clinical and radiologic findings, as well as clinical outcomes as defined by follow-up or pathologic findings.

RESULTS:

Thirteen pediatric emergency medicine sonographers performed 264 ultrasonographic studies, including 85 (32%) in children with pathology-verified appendicitis. Bedside sonography had a sensitivity of 85% (95% confidence interval [CI] 75% to 95%), specificity of 93% (95% CI 85% to 100%), positive likelihood ratio of 11.7 (95% CI 6.9 to 20), and negative likelihood ratio of 0.17 (95% CI 0.1 to 0.28).

CONCLUSION:

With focused ultrasonographic training, pediatric emergency physicians can diagnose acute appendicitis with substantial accuracy.

[Indexed for MEDLINE]

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