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J Emerg Med. 2017 Jun;52(6):833-838. doi: 10.1016/j.jemermed.2017.01.003. Epub 2017 Feb 28.

Ultrasound for Diagnosis of Appendicitis in a Community Hospital Emergency Department has a High Rate of Nondiagnostic Studies.

Author information

1
Division of Emergency Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida.
2
Department of Emergency Medicine, Morristown Medical Center, Morristown, New Jersey.
3
Department of Emergency Medicine, California Hospital Medical Center, Los Angeles, California.

Abstract

BACKGROUND:

Radiation concerns are changing the way emergency physicians evaluate patients. This is especially prevalent in pediatrics, and exemplified by abdominal pain management. Large academic center-based studies suggest appendix ultrasound (U/S) is sensitive and specific for appendicitis, with low nondiagnostic rates.

OBJECTIVES:

We sought to determine the diagnostic rate of appendix U/S and incidence of follow-up computed tomography (CT) imaging for pediatric patients at a community hospital.

METHODS:

Design: Retrospective cohort.

SETTING:

Emergency department with 85,000 annual visits.

POPULATION:

Patients younger than 21 years old that had an appendix U/S over a 12-month period. U/S were performed by technicians and interpreted by radiologists. Investigators classified readings as "diagnostic" ("positive" and "negative") or "non-diagnostic" ("borderline" and "appendix not visualized") and identified follow-up CT studies and interpretations.

RESULTS:

There were 441 pediatric appendix U/S performed; 26% were diagnostic (14% positive for appendicitis, 12% negative) and 74% nondiagnostic (5% borderline, 69% appendix not visualized). Follow-up CT scans were obtained in 19% of all patients, including 8% with positive U/S, 4% negative, 32% borderline, and 22% not visualized. Follow-up CT was nearly four times more likely in the nondiagnostic group than the diagnostic group (23% vs. 6%, p < 0.0001).

CONCLUSION:

The utility of U/S to diagnose appendicitis at a community hospital is limited by a high rate of nondiagnostic studies. Some patients with diagnostic U/S even had follow-up CT imaging. To minimize radiation exposure in children, improvements should be made in the performance and acceptance of U/S as the primary modality of abdominal pain imaging at community hospitals.

KEYWORDS:

appendix; community; emergency; pediatrics; ultrasound

PMID:
28258881
DOI:
10.1016/j.jemermed.2017.01.003
[Indexed for MEDLINE]

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