title: Limited Abdominal Sonography for Evaluation of Children With Right Lower Quadrant Pain.
abstract: OBJECTIVE
  To determine whether a complete abdominal sonographic examination is necessary in the evaluation of children with right lower quadrant pain that is suspicious for appendicitis in the emergency department and whether performing a limited, more-focused study would miss clinically important disease.
  
  
  METHODS
  With Institutional Review Board approval, a retrospective study was performed of 704 patients, from ages 5-19 years, presenting to the emergency department with right lower quadrant pain that was suspicious for appendicitis who underwent a complete abdominal sonographic examination. Data were extracted from the complete abdominal sonographic examination to see whether abnormalities were noted in the pancreas, spleen, and left kidney. Patients' medical charts were reviewed to see whether any positive findings in these organs were clinically important.
  
  
  RESULTS
  Of the 65 studies with a finding that would have been missed with a limited study, only 6 were found to be clinically important. Of those, 5 were managed medically and 1 surgically. The chance of missing a potentially important finding using a limited study with our group of patients was 65 of 704 patients (9.2%), with a 95% confidence interval of 7.2% to 11.7%. The chance of missing an abnormality that was clinically important was 6 of 704 patients (0.85%), with a 95% confidence interval of 0.35% to 1.94%.
  
  
  CONCLUSIONS
  In children older than 5 years with abdominal pain that is suspicious for appendicitis, performing only a limited abdominal sonographic examination that excludes the pancreas, left kidney, and spleen will yield a miss rate for clinically important disease that is acceptably low to justify the savings of examination time.
authors.affiliation: Texas Children's Hospital, Houston, Texas, USA.
authors.forename: Martha M
authors.initials: MM
authors.lastname: Munden
authors.affiliation: Rady Children's Hospital, San Diego, California, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Wai
authors.affiliation: Children's Hospital Colorado, Aurora, Colorado, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: DiStefano
authors.affiliation: Texas Children's Hospital, Houston, Texas, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
mesh_terms: D034841:Abdominal Cavity / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: appendicitis; limited sonography; pediatric ultrasound; pediatrics