title: The impact of ultrasound examinations on the management of children with suspected appendicitis: a 3-year analysis.
abstract: OBJECTIVE
  The aim of this study was to evaluate the usefulness of ultrasonography in the routine management of children with suspected appendicitis in a children's hospital.
  
  
  METHODS
  Data from surgical, radiologic, and pathologic databases were cross referenced retrospectively to allow for review of all children undergoing appendectomy and all children undergoing an ultrasound scan to rule out appendicitis in the 3-year period August 1, 1996 to July 31, 1999.
  
  
  RESULTS
  Pathology reports were available for 1,007 of 1,032 patients undergoing appendectomy. Eighty-four percent had acute appendicitis (26% of these were perforated). Fifty-eight percent of all children undergoing appendectomy had at least 1 preoperative ultrasound scan. Eighty-six percent of those having ultrasound scans had acute appendicitis compared with 82% of those who did not have an ultrasound scan (P <.05 chi(2) Test). During the same period, 2,056 ultrasound examinations were performed by staff radiologists who were available 24 hours a day to rule out appendicitis. Ultrasonography in this setting had a sensitivity of 89%, specificity of 95%, positive predictive value of 86%, and a negative predictive value of 96% (true-positives, n = 496; false-positive, n = 81; true-negative, n = 1,417; false-negative, n = 62). An alternate ultrasound diagnosis was offered in 157 children.
  
  
  CONCLUSIONS
  Ultrasound scan improves diagnostic accuracy in children with suspected appendicitis. The high negative predictive value of ultrasound scan, especially when used repeatedly, may reduce the need for admission to hospital for clinical observation to rule out appendicitis.
authors.affiliation: Department of Surgery, Texas Children's Hospital, Houston, TX 77030-2399, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dilley
authors.forename: D
authors.initials: D
authors.lastname: Wesson
authors.forename: M
authors.initials: M
authors.lastname: Munden
authors.forename: J
authors.initials: J
authors.lastname: Hicks
authors.forename: M
authors.initials: M
authors.lastname: Brandt
authors.forename: P
authors.initials: P
authors.lastname: Minifee
authors.forename: J
authors.initials: J
authors.lastname: Nuchtern
mesh_terms: D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000191:economics