Abdominal ultrasound in the diagnosis of childhood appendicitis
- Report By: Rob Williams - Specialist Registrar
- Search checked by Kevin Mackway-Jones - Consultant
- Institution: MRI
- Current web editor: Minnie Alexander - Senior Information Officer
- Date Submitted: 1st March 2000
- Date Completed: 22nd February 2001
- Last Modified: 28th May 2001
-
Status:
Green (complete)
Three Part Question
In [a paediatric patient with clinical signs of appendicitis] how [useful is an ultrasound scan] at [confirming or refuting the diagnosis]?Clinical Scenario
An 8 year old patient presents to the emergency department with a six hour history of right iliac fossa pain; examination is suggestive of acute appendicitis. You wonder whether an ultrasound scan would be helpful for diagnosis.Search Strategy
Medline 1966-12/00 using the OVID interface.{[(exp child OR children.mp OR exp pediatrics OR pediatric.mp OR paediatric.mp) AND (exp appendicitis OR acute appendicitis.mp)] AND (exp ultrasonography OR ultrasonography.mp OR exp ultrasonics OR ultrasonics.mp OR ultrasound.mp)} LIMIT to human AND english.
Search Outcome
Altogether 173 papers found of which 170 were irrelevant or of insufficient quality for inclusion. The remaining 3 papers are shown below.Relevant Paper(s)
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Hahn HB et al, 1998, Germany | 3859 children age 1-17 years with suspected acute appendicitis. Gold standard was operative findings or result of clinical observation and repeat ultrsouond | Diagnostic cohort | Appendicitis | Sensitivity 90% Specificity 97% LR +30 LR -0.1 | Inhospital follow up only |
| Schulte B et al, 1998, Germany | 1285 children age 1-15 years with acute appendicitis Gold standard was operative findings or result of clinical follow up | Diagnostic cohort | Appendicitis | Sensitivity 92% Specificity98% LR +42 LR -0.08 | Follow up rate unclear Follow up time not specified |
| Sivit CJ et al, 2000, USA | 386 patients age 1-21 years with suspected acute appendicitis. Analysed for under and over 10 year olds Gold standard was operative findings or result of clinical follow up | Daignostic cohort | Appendicitis <10 years old | Sensitivity 71% Specificity 96% LR +5.1 LR -0.34 | Unblinded Excludes an unknown number of "obvious" appendicitis cases |
| Appendicitis >10 years old | Sensitivity 84% Specificity 86% LR +6 LR -0.18 |
Comment(s)
These studies show that ultrasound has a high sensitivity and specificity for the diagnosis of appendicitis. While specificity is high enough to SpIn, sensitivity is too low to SnOut. Further work investigating the diagnostic utility in high, moderate and low risk groups is warranted.Clinical Bottom Line
A positive ultrasound is highly specific and can be used to rule in appendicitis in children. Sensitivity of this test is too low to rule out the diagnosis.References
- Hahn HB, Hoepner FU, Kalle T, et al. Sonography of acute appendicitis in children: 7 years experience. Paediatr Radiol 1998;28:147-51.
- Schulte B, Beyer D, Kaiser C, et al. Ultrasonography in suspected acute appendicitis in childhood-report of 1285 cases. Eur J Ultrasound 1998;8:177-82.
- Sivit CJ, Kimberly AE, Stallion A, et al. Imaging evaluation of suspected appendicitis in a paediatric population: effectiveness of sonography versus CT. Am J Radiol 2000;175:977-80.