title: Reevaluating the sonographic criteria for acute appendicitis in children: a review of the literature and a retrospective analysis of 246 cases.
abstract: OBJECTIVE
  There has been little rigorous evaluation of the sonographic criteria for acute appendicitis in children. Our clinical experience has called the traditional diagnostic criteria into question. We set out to review the literature, evaluate the most commonly applied diagnostic criteria for acute appendicitis, and identify those criteria that best predict the presence of disease.
  
  
  METHODS
  A critical review of the literature concerning the sonographic diagnosis of acute appendicitis was performed. Based on diagnostic criteria identified in that review, two independent, blinded pediatric radiologists retrospectively reviewed 246 right lower quadrant ultrasound examinations in which the appendix was identified with attention to commonly described diagnostic criteria for acute appendicitis. Multivariate and classification and regression tree analysis were performed to identify criteria that predict appendicitis.
  
  
  RESULTS
  In a multivariate analysis, inflammation of the periappendiceal fat is the only finding that statistically significantly predicts acute appendicitis (OR = 68.93, P < .0001). Other criteria such as diameter, noncompressibility, hyperemia, the presence of an appendicolith, and loss of stratification of the appendiceal wall do not independently predict appendicitis.
  
  
  CONCLUSIONS
  Periappendiceal fat infiltration is the most important diagnostic criterion for acute appendicitis in children. Strict application of other criteria such as diameter should be avoided.
authors.affiliation: Department of Radiology, Section of Pediatric Radiology, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, 48109-4252, USA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Trout
authors.forename: Ramon
authors.initials: R
authors.lastname: Sanchez
authors.forename: Maria F
authors.initials: MF
authors.lastname: Ladino-Torres
mesh_terms: D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology