Ultrasonography aids decision-making in children with abdominal pain

Abstract

Ultrasonography is used liberally to aid in the decision making process of equivocal and complicated cases of acute appendicitis and it achieves good measures of accuracy. As a diagnostic tool it is unique in its ability to positively predict as well as exclude. A high negative predictive value suggests that more patients could be managed on an outpatient basis following a negative scan.

Limits and advantages of abdominal ultrasonography in children with acute appendicitis syndrome

“…[2] In our experience, the estimated negative appendectomy rate is 14%, comparable to other studies, while the perforation rate is 8% less than in other reports. [20] We agree that all the values considered could be improved if USs were performed by dedicated paediatric radiologists. Overall, the present results are encouraging and support the diagnostic strategy that US should be routine for all children with suspected appendicitis.…”

When does ultrasonography influence management in suspected appendicitis?

“…The overall US rate in our study was lower than some other series, but this may reflect that active observation with serial clinical examination of the patient is considered a legitimate and valid management strategy in both centres. There is a tendency to reserve US for equivocal or difficult cases.…”

“…All the clinical and investigative information must be taken into account together when deciding whether an operation is required, and US should not be seen as an isolated diagnostic tool. 9 The overall US rate in our study was lower than some other series, 9,10 but this may reflect that active observation with serial clinical examination of the patient is considered a legitimate and valid management strategy in both centres. There is a tendency to reserve US for equivocal or difficult cases.…”

“…There is a tendency to reserve US for equivocal or difficult cases. Routine US is probably unnecessary where the clinical features clearly indicate appendicitis, but combining US with repeated clinical observation is a useful diagnostic strategy for those children where the features are less typical.…”

A Combination of Clinical Examination with Specific Biomarkers and Judicious Use of Imaging Modality can Reduce the Rates of Negative Appendicectomy.

“…Present study was also consistent with the study done by MojcaGroselj-Grenc et al 12 having sensitivity of 91% and specificity of 95% respectively. Accuracy of CT scan is higher as compared to USG for diagnosing acute appendicitis 20 but till today still there is utility of USG for the diagnosis of acute appendicitis particularly in pediatric cases 21 . CECT was not performed routinely in all patients but done only when there was discordance between clinical findings and Ultrasonography.…”