Paediatric appendiceal ultrasound: a survey of Australasian sonographers’ opinions on examination performance and sonographic criteria

Abstract

IntroductionThe objectives of this study were to identify knowledge gaps and/or perceived limitations in the performance of paediatric appendiceal ultrasound by Australasian sonographers. We hypothesised that: sonographers’ confidence in visualising the appendix in children was poor, particularly outside predominantly paediatric practice; workplace support for prolonging examinations to improve visualisation was limited; and the sonographic criteria applied in diagnosis did not reflect contemporary literature.MethodsA cross‐sectional survey of Australasian sonographers regarding paediatric appendicitis was conducted using a mixed methods approach (quantitative and qualitative data). Text responses were analysed for key themes, and quantitative data analysed using chi‐square, Mann–Whitney U and Wilcoxon signed‐rank tests.ResultsOf the 124 respondents, 27 (21.8%) reported a visualisation rate of less than 10%. Workplace support for extending examination time was significantly related to a higher appendix visualisation rate (χ 2(2) = 16.839, P < 0.001). Text responses reported frustration locating the appendix and a desire for more time and practice to improve visualisation. Sonographers suggested a significantly lower maximum diameter cut‐off in a 5‐year‐old compared to a 13‐year‐old (Z = −6.07, P < 0.001), and considered the presence of inflamed peri‐appendiceal mesentery as the most useful sonographic criterion in diagnosing acute appendicitis.ConclusionsRespondents had a low opinion of their ability to confidently identify the appendix. Confidence was greater in those centres where extending scanning time was encouraged. Application of echogenic mesentery as the most significant secondary sonographic criterion is supported by recent studies. Opinions of diameter cut‐offs varied, indicating potential for improved awareness of recent research.

Does age affect the test performance of secondary sonographic findings for pediatric appendicitis?

“…The prevalence of secondary findings did not vary significantly between the different age groups. Echogenic right lower quadrant fat was the most predictive secondary sonographic finding for appendicitis across all age groups, which confirms similar findings in other studies of pediatric [21][22][23] and adult appendicitis [24]. The sonographic visualization of an appendicolith was more accurate for the diagnosis of appendicitis in the youngest age group as compared to the older two age groups.…”

Bayesian Approach to Predicting Acute Appendicitis Using Ultrasonographic and Clinical Variables in Children

“…The use of a visual representation of a decision-making model like a DAG in a BN is an elegant means to enable appreciation of a broader clinical picture. A recent survey of sonographers who perform paediatric appendicitis ultrasound in Australasia highlighted that they often feel removed from clinical decision-making considerations, and a better appreciation of the degree of suspicion of children to have appendicitis would assist them in performing their examinations [31]. Appendiceal sonography may require dedicated time and focus that can conflict with demands for activity and efficiency [32].…”