Does Right Lower Quadrant Abdominal Ultrasound Accurately Identify Perforation in Pediatric Acute Appendicitis?

Diagnostic Performance of US for Differentiating Perforated from Nonperforated Pediatric Appendicitis: A Prospective Cohort Study

“…During the study period, 4183 limited abdominal US examinations were performed to evaluate for suspected (11,(17)(18)(19). Previously published studies reporting the diagnostic performance of US for suspected pediatric appendicitis are limited by retrospective designs, small subject numbers, and restrictive exclusion criteria (8,9). Our study included all patients with suspected appendicitis in whom the appendicitis scoring system had been used, including children with possible alternative diagnoses or challenging body habitus.…”

“…Ultrasonography (US) is a preferred modality for diagnosing pediatric appendicitis because of its high diagnostic accuracy, ready availability, noninvasive nature, and lack of ionizing radiation or contrast medium administration (7). However, recent studies in both adults and children report poor US accuracy for differentiating perforated from nonperforated appendicitis, with published sensitivities ranging from 23% to 48% and specificities ranging from 93% to 100% (8,9). Although these studies support our hypothesis that US sensitivity for perforated pediatric appendicitis is poor, prospective studies with sufficient patient numbers to allow calculation of reliable test performance measures have not been performed.…”

Diagnostic performance of ultrasound to differentiate perforated from non‐perforated paediatric appendicitis: A narrative review

“…The studies reviewed (Table 1) show that ultrasound has high specificity ranging from 90% to 100%, but low sensitivity ranging from 23% to 44% to distinguish perforated paediatric appendicitis (Table 2) 39,40,42,43 and indicate that the use of a scoring system may be beneficial (Table 3). 42 Sonographic findings with high specificity but low sensitivity to differentiate perforated from non-perforated paediatric appendicitis include the presence of an abscess 7,38 loculated or complex intraperitoneal fluid, 38,43 the presence of an appendicolith, 7,38 dilated bowel 38 and wall thickening of the terminal ileum 43 (Table 4).…”

“…3 The literature explores the diagnostic performance and findings of ultrasound for differentiating perforated from non-perforated paediatric appendicitis and demonstrates that ultrasound is a useful first-line imaging choice to exclude perforated appendicitis in children. 7,[38][39][40]42,43 4.1 | Diagnostic performance of ultrasound…”

“…Ultrasound has high specificity, but low sensitivity to distinguish perforated appendicitis in children (Table 2). 39,40,42,43 While the low sensitivity suggests that ultrasound is a poor tool to diagnose perforation as opposed to non-perforated paediatric appendicitis, 40 the high specificity means it can be effective to exclude perforation in children with suspected appendicitis. 39 However, the studies were mostly retrospective with small sample sizes (Table 1), so more prospective studies with larger sample sizes are needed for future research of the specificity and sensitivity of ultrasound to diagnose perforated appendicitis in the paediatric population.…”