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J Pediatr Surg. 2016 Oct;51(10):1655-60. doi: 10.1016/j.jpedsurg.2016.03.005. Epub 2016 Mar 12.

Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children.

Author information

1
Emory University School of Medicine, Atlanta, GA, USA.
2
Emory College, Emory University, Atlanta, GA, USA.
3
Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
4
Division of Pediatric Radiology, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
5
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
6
Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA. Electronic address: mehulvraval@emory.edu.

Abstract

INTRODUCTION:

Ultrasound (US) is the preferred imaging modality for evaluating appendicitis. Our purpose was to determine if including secondary signs (SS) improve diagnostic accuracy in equivocal US studies.

METHODS:

Retrospective review identified 825 children presenting with concern for appendicitis and with a right lower quadrant (RLQ) US. Regression models identified which SS were associated with appendicitis. Test characteristics were demonstrated.

RESULTS:

530 patients (64%) had equivocal US reports. Of 114 (22%) patients with equivocal US undergoing CT, those with SS were more likely to have appendicitis (48.6% vs 14.6%, p<0.001). Of 172 (32%) patients with equivocal US admitted for observation, those with SS were more likely to have appendicitis (61.0% vs 33.6%, p<0.001). SS associated with appendicitis included fluid collection (adjusted odds ratio (OR) 13.3, 95% confidence interval (CI) 2.1-82.8), hyperemia (OR=2.0, 95%CI 1.5-95.5), free fluid (OR=9.8, 95%CI 3.8-25.4), and appendicolith (OR=7.9, 95%CI 1.7-37.2). Wall thickness, bowel peristalsis, and echogenic fat were not associated with appendicitis. Equivocal US that included hyperemia, a fluid collection, or an appendicolith had 96% specificity and 88% accuracy.

CONCLUSION:

Use of SS in RLQ US assists in the diagnostic accuracy of appendicitis. SS may guide clinicians and reduce unnecessary CT and admissions.

KEYWORDS:

Appendicitis; Pediatric surgery; Quality improvement; Secondary signs; Ultrasound

PMID:
27039121
PMCID:
PMC5018916
DOI:
10.1016/j.jpedsurg.2016.03.005
[Indexed for MEDLINE]
Free PMC Article

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