title: Ultrasound-based decision making in the treatment of acute appendicitis in children.
abstract: OBJECTIVE
  Imaging techniques are used widely to diagnose appendicitis. However, the negative appendectomy rate remains at about 15%. The authors assessed ultrasound-based decision making in the treatment of acute appendicitis in children.
  
  
  METHODS
  The authors prospectively studied 165 consecutive children (3 to 15 years old) evaluated for appendicitis. Diagnosis and treatment were based solely on ultrasound scan findings. Criterion for appendicitis was a diameter exceeding 6 mm. Severity was classified into 4 grades based on the appearance of intramural appendiceal structure. Patients with grades I or II received antibiotic therapy. Patients with grades III or IV underwent appendectomy.
  
  
  RESULTS
  Ultrasound scan diagnosed appendicitis in 93 children (grade I, 7; grade II, 17; grade III, 41; and grade IV, 28). All but 2 patients with grades I or II underwent antibiotic therapy without complication. All grades III or IV patients underwent appendectomy. There was no negative appendectomy among 76 appendectomies during this period. Ultrasound-based prediction of severity was correct in 67 cases (88%). Ultrasonography identified other pathology in 39.
  
  
  CONCLUSIONS
  Ultrasonography in children cannot only visualize all inflamed appendices but also predict severity of disease. Treatment based entirely on ultrasound scan identified patients who required surgery for severe appendicitis and permitted successful conservative treatment for mild appendicitis.
authors.affiliation: Department of Pediatric Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi Prefecture, Japan.
authors.forename: Kenitiro
authors.initials: K
authors.lastname: Kaneko
authors.forename: Mineyuki
authors.initials: M
authors.lastname: Tsuda
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003108:Colonic Diseases / Q000000981:diagnostic imaging; D003248:Constipation / Q000000981:diagnostic imaging; D003663:Decision Trees; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005734:Gangrene; D006801:Humans; D007079:Ileitis / Q000000981:diagnostic imaging; D007443:Intussusception / Q000000981:diagnostic imaging; D008297:Male; D008640:Mesenteric Lymphadenitis / Q000000981:diagnostic imaging; D010048:Ovarian Cysts / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D013492:Suppuration; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C045693:flomoxef