Clinical validity of ultrasound in children with suspected appendicitis.

STUDY OBJECTIVE: To determine the accuracy of diagnosing appendicitis in the pediatric population by using graded compression ultrasonography.

DESIGN: Retrospective case review.

SETTING: University-affiliated community hospital with an emergency department census of approximately 19,000 pediatric visits per year.

TYPE OF PARTICIPANTS: Ninety-eight children (age less than 13 years) with clinically suspected appendicitis who had graded compression sonographic studies during the 24-month study period.

INTERVENTIONS: Medical records were reviewed for patient demographics, presenting signs and symptoms, sonographic findings, surgical results, and hospital course. Patients who did not undergo surgery were followed up by telephone for a minimum of two months.

RESULTS: Ninety-eight children (42 boys and 56 girls; age range, 2 to 12 years; mean age, 8.0 years) with clinical signs and symptoms of acute appendicitis were examined sonographically. Of the 26 patients whose appendicitis was verified at surgery, ultrasound was positive in 22, with an overall sensitivity of 85%. Of the 72 patients who did not have appendicitis, ultrasound was negative in 68, with a specificity of 94%. Two patients with false-positive ultrasound went to surgery and were found to have acute ileitis and perforated Meckel's diverticulum. The overall diagnostic accuracy was 91.8% (90 of 98).

CONCLUSION: Use of ultrasound to diagnose acute appendicitis was performed with a sensitivity of 85% and a specificity of 94%. This allows the same accuracy in children as has been reported with adults.