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Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy

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Abstract

Background

Use of CT in the evaluation of suspected appendicitis in children is common. Expanding the use of US would eliminate the radiation exposure associated with CT.

Objective

We describe new criteria that improve US’s diagnostic accuracy for appendicitis, making it more comparable to CT in terms of sensitivity and specificity.

Materials and methods

We conducted a retrospective review of 304 consecutive patients undergoing US for the diagnosis of appendicitis in our institution during 2006. The sensitivity, specificity and accuracy of the maximal outer diameter (MOD) at various measurements was calculated and compared to pathology results. Additional variables (appendiceal wall thickness, fecalith, hyperemia, fat stranding, free fluid, age and weight) were also evaluated.

Results

The highest sensitivity (98.7%) and specificity (95.4%) were identified when MOD was ≥7 mm or wall thickness was >1.7 mm. These values resulted in correctly classifying 96.6% of cases, with 1 (0.5%) false-negative and 6 (2.9%) false-positive studies. Incorporating secondary signs of appendicitis, age or weight did not alter accuracy.

Conclusion

These findings identify new US criteria that compare favorably to CT. In children with suspected appendicitis, using US as the initial imaging study will ultimately lead to improved accuracy, lower cost and the elimination of ionizing radiation exposure.

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Authors and Affiliations

  1. Department of Pediatric General and Thoracic Surgery, Seattle Children’s Hospital, 4800 Sand Point Way NE, M/S W-7729, P.O. Box 5371, Seattle, WA, 98105, USA

    Adam B. Goldin

  2. Department of Surgery, University of Washington, Seattle, WA, USA

    Adam B. Goldin

  3. Department of Radiology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Paritosh Khanna, Mahesh Thapa, Jennifer A. McBroom & Marguerite T. Parisi

  4. Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Marguerite T. Parisi

  5. Center for Child Health, Behavior, and Development, Seattle Children’s Hospital, Seattle, WA, USA

    Michelle M. Garrison

Authors
  1. Adam B. Goldin
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  2. Paritosh Khanna
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  3. Mahesh Thapa
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  4. Jennifer A. McBroom
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  5. Michelle M. Garrison
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  6. Marguerite T. Parisi
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Correspondence to Adam B. Goldin.

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Goldin, A.B., Khanna, P., Thapa, M. et al. Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy. Pediatr Radiol 41, 993–999 (2011). https://doi.org/10.1007/s00247-011-2018-2

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  • DOI: https://doi.org/10.1007/s00247-011-2018-2

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