Benchmarking the value of ultrasound for acute appendicitis in children.
BACKGROUND
This study appraises the diagnostic quality of ultrasound for acute appendicitis in children and consequently challenges the perception of inferior accuracy and suitability compared to computed tomography (CT).


METHODS
Radiologist reports for consecutive "query appendicitis" ultrasound studies were retrieved from a hospital database for the study period 2009-2014. Children who subsequently underwent appendicectomy were identified. Corresponding operative and histopathology findings were evaluated. Diagnostic accuracy of ultrasound was determined by analyzing overall accuracy, sensitivity, specificity, predictivity, and likelihood ratios.


RESULTS
A total of 3799 ultrasound examinations were evaluated. Mean age was 11.5±3.8years. The proportion of patients investigated with preoperative ultrasound was 59.9% (1103/1840). Appendix visualization rate was 91.7%. Overall diagnostic accuracy was 95.5%. Sensitivity and specificity values were 97.1% (95.9-98.1; 95% CI) and 94.8% (93.9-95.6; 95% CI), respectively. Separate analysis of only ultrasound positive and negative examinations (i.e., excluding nondiagnostic examinations) confirmed sensitivity and specificity values of 98.8% and 98.3%.


CONCLUSIONS
In this largest reported single institution series of ultrasound examinations for appendicitis, we report benchmark standard quality of diagnostic accuracy and visualization rates. Given the radiation and cost implications of CT, there is a strong argument to recommend ultrasound as the primary imaging modality. Diagnostic Study-Level II.
Department of Paediatric Surgery, Women's and Children's Hospital, South Australia; Discipline of Surgery, University of Adelaide, South Australia. Electronic address: thomas.cundy@adelaide.edu.au.
Thomas P
TP
Cundy
Department of Radiology, Women's and Children's Hospital, South Australia.
Roger
R
Gent
Department of Paediatric Surgery, Women's and Children's Hospital, South Australia.
Claire
C
Frauenfelder
Department of Radiology, Women's and Children's Hospital, South Australia.
Laura
L
Lukic
Department of Radiology, Women's and Children's Hospital, South Australia.
Rebecca J
RJ
Linke
Department of Paediatric Surgery, Women's and Children's Hospital, South Australia; Discipline of Paediatrics, School of Medicine, University of Adelaide, South Australia.
Day Way
DW
Goh
D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D001065:Appendix / Q000000981:diagnostic imaging* / Q000601:surgery; D019985:Benchmarking; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
Appendicitis; Pediatric; Ultrasound