Abdominal ultrasound in the diagnosis of childhood appendicitis
Date First Published:
March 1, 2000
Last Updated:
May 28, 2001
Report by:
Rob Williams, Specialist Registrar (MRI)
Search checked by:
Kevin Mackway-Jones, MRI
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.
Search Details:
{[(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.
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):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Sonography of acute appendicitis in children: 7 years experience. Hahn HB, Hoepner FU, Kalle T, 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%<br><br>Specificity 97%<br><br>LR +30<br><br>LR -0.1 | Inhospital follow up only |
| Ultrasonography in suspected acute appendicitis in childhood-report of 1285 cases. Schulte B, Beyer D, Kaiser C, 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%<br><br>Specificity98%<br><br>LR +42<br><br>LR -0.08 | Follow up rate unclear Follow up time not specified |
| Imaging evaluation of suspected appendicitis in a paediatric population: effectiveness of sonography versus CT. Sivit CJ, Kimberly AE, Stallion A, 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%<br><br>Specificity 96%<br><br>LR +5.1<br><br>LR -0.34 | Unblinded Excludes an unknown number of "obvious" appendicitis cases |
| Appendicitis >10 years old | Sensitivity 84%<br><br>Specificity 86%<br><br>LR +6<br><br>LR -0.18 |
Author Commentary:
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.
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.
- Schulte B, Beyer D, Kaiser C, et al.. Ultrasonography in suspected acute appendicitis in childhood-report of 1285 cases.
- Sivit CJ, Kimberly AE, Stallion A, et al.. Imaging evaluation of suspected appendicitis in a paediatric population: effectiveness of sonography versus CT.