The Effect of a Full Bladder on Proportions of Diagnostic Ultrasound Studies in Children with Suspected Appendicitis

Abstract

Objectives: We examined the effect of a full bladder on proportions of diagnostic ultrasound (US) studies in children with suspected appendicitis. We also examined the effect of a full bladder on proportions of fully visualized ovaries on US in children with suspected appendicitis. Methods: We conducted a retrospective health record review of children aged 2-17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis who had an ultrasound performed. We compared proportions of diagnostic US studies in children with full and sub-optimally filled bladders. We also compared proportions of ovarian visualization in females with full and sub-optimally filled bladders. Results: 678 children were included in our final analysis. The proportion of diagnostic US studies did not vary significantly between groups with a full (132/283, 47%, 95% confidence interval [CI] 38%-56%) or sub-optimally filled bladder (205/ 395, 52%, 95% CI 47%-57%) (p = 0.17). Rates of ovarian visualization were higher in females with a full bladder (196/ 205, 96%, 95% CI 93%-99%) compared to those with a suboptimally filled bladder (180/223, 81%, 95% CI 76%-86%) (p < 0.01). Conclusions: Administrators and clinical decision makers should consider removing routine bladder filling practice from current pediatric appendicitis protocols in males and in pre-pubertal females where ovarian pathology is not suspected. Selective bladder filling prior to US should be performed in females when ovarian pathology is suspected. Conclusions: Les gestionnaires et les décideurs en matière de pratiques cliniques devraient envisager le retrait du remplissage systématique de la vessie, des protocoles actuels de traitement de l'appendicite, chez les garçons et chez les filles prépubères ainsi que chez les filles chez qui tout doute d'affection des ovaires est écarté. Par contre, on devrait procéder à un remplissage sélectif de la vessie avant une échographie chez les filles chez qui il y a des doutes quant à l'existence d'une affection des ovaires.

Cytokines and Chemokines in Pediatric Appendicitis: A Multiplex Analysis of Inflammatory Protein Mediators

“…), laboratory investigations (WBC, neutrophils +/- CPR) [1], and imaging studies (ultrasound) [40]. While often useful in the first-line work-up of a child with suspected appendicitis, these strategies remain limited because (a) children often present with atypical symptoms [41, 42], (b) clinical scoring systems and conventional laboratory investigations have suboptimal test characteristics (sensitivities and specificities in the 70-85% range) [1, 43–45], and (c) ultrasound is known to have high rates of incomplete visualization [46–49], may be painful for the child (compression on an already tender abdomen), and in females requires a full bladder (for optimal evaluation of pelvic organs) [50]. Second-line/advanced imaging techniques are limited by exposure of developing organs to unacceptable levels of ionizing radiation (computed tomography) [51] or have limited accessibility outside tertiary settings (magnetic resonance imaging).…”