title: Evaluation of acute appendicitis by pediatric emergency physician sonography.
abstract: OBJECTIVE
  We investigate the accuracy of pediatric emergency physician sonography for acute appendicitis in children.
  
  
  METHODS
  We prospectively enrolled children requiring surgical or radiology consultation for suspected acute appendicitis at an urban pediatric emergency department. Pediatric emergency physicians performed focused right lower-quadrant sonography after didactics and hands-on training with a structured scanning algorithm, including the graded-compression technique. We compared their sonographic interpretations with clinical and radiologic findings, as well as clinical outcomes as defined by follow-up or pathologic findings.
  
  
  RESULTS
  Thirteen pediatric emergency medicine sonographers performed 264 ultrasonographic studies, including 85 (32%) in children with pathology-verified appendicitis. Bedside sonography had a sensitivity of 85% (95% confidence interval [CI] 75% to 95%), specificity of 93% (95% CI 85% to 100%), positive likelihood ratio of 11.7 (95% CI 6.9 to 20), and negative likelihood ratio of 0.17 (95% CI 0.1 to 0.28).
  
  
  CONCLUSIONS
  With focused ultrasonographic training, pediatric emergency physicians can diagnose acute appendicitis with substantial accuracy.
authors.affiliation: Department of Emergency Medicine, Newark Beth Israel Medical Center, Children's Hospital of New Jersey, Newark, NJ. Electronic address: asivitz@barnabashealth.org.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Sivitz
authors.affiliation: Department of Pediatric Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Cohen
authors.affiliation: Department of Emergency Medicine, Newark Beth Israel Medical Center, Children's Hospital of New Jersey, Newark, NJ.
authors.forename: Cena
authors.initials: C
authors.lastname: Tejani
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000000981:diagnostic imaging*; D002648:Child; D002983:Clinical Competence; D004635:Emergency Medicine / Q000193:education; D005260:Female; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000193:education; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011871:Radiology; D012680:Sensitivity and Specificity; D014463:Ultrasonography