title: The Effect of a Full Bladder on Proportions of Diagnostic Ultrasound Studies in Children with Suspected Appendicitis.
abstract: OBJECTIVE
  We examined the effect of a full bladder on proportions of diagnostic ultrasound (US) studies in children with suspected appendicitis. We also examined the effect of a full bladder on proportions of fully visualized ovaries on US in children with suspected appendicitis.
  
  
  METHODS
  We conducted a retrospective health record review of children aged 2-17 years presenting to a tertiary pediatric emergency department (ED) with suspected appendicitis who had an ultrasound performed. We compared proportions of diagnostic US studies in children with full and sub-optimally filled bladders. We also compared proportions of ovarian visualization in females with full and sub-optimally filled bladders.
  
  
  RESULTS
  678 children were included in our final analysis. The proportion of diagnostic US studies did not vary significantly between groups with a full (132/283, 47%, 95% confidence interval [CI] 38%-56%) or sub-optimally filled bladder (205/395, 52%, 95% CI 47%-57%)(p=0.17). Rates of ovarian visualization were higher in females with a full bladder (196/205, 96%, 95% CI 93%-99%) compared to those with a sub-optimally filled bladder (180/223, 81%, 95% CI 76%-86%) (p<0.01).
  
  
  CONCLUSIONS
  Administrators and clinical decision makers should consider removing routine bladder filling practice from current pediatric appendicitis protocols in males and in pre-pubertal females where ovarian pathology is not suspected. Selective bladder filling prior to US should be performed in females when ovarian pathology is suspected.
authors.affiliation: *Department of Emergency Medicine,University of Calgary,Calgary,AB.
authors.forename: Marshall
authors.initials: M
authors.lastname: Ross
authors.affiliation: ¶Medical Undergraduate at University of Limerick,Limerick,Ireland.
authors.forename: Sasha
authors.initials: S
authors.lastname: Selby
authors.affiliation: ǁDepartment of Pediatrics,Western University,London, ON.
authors.forename: Naveen
authors.initials: N
authors.lastname: Poonai
authors.affiliation: **Department of Medical Education,University of Alberta,Edmonton,AB.
authors.forename: Helena
authors.initials: H
authors.lastname: Liu
authors.affiliation: †Pediatric Emergency Medicine,University of Calgary,Calgary,AB.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Minoosepehr
authors.affiliation: ‡Department of Radiology,University of Calgary,Calgary,AB.
authors.forename: Graham
authors.initials: G
authors.lastname: Boag
authors.affiliation: §Department of Pediatric Surgery,University of Calgary,Calgary,AB.
authors.forename: Robin
authors.initials: R
authors.lastname: Eccles
authors.affiliation: †Pediatric Emergency Medicine,University of Calgary,Calgary,AB.
authors.forename: Graham
authors.initials: G
authors.lastname: Thompson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001064:Appendicitis / Q000175:diagnosis* / Q000601:surgery; D002170:Canada; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016017:Odds Ratio; D009929:Organ Size; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012737:Sex Factors; D014463:Ultrasonography / Q000379:methods*; D001743:Urinary Bladder / Q000000981:diagnostic imaging* / Q000502:physiology
keywords: Appendicitis; diagnosis; pediatrics; ultrasound