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Ultrasound scan as a diagnostic adjunct in acute appendicitis in children
EP34294
Poster Title: Ultrasound scan as a diagnostic adjunct in acute appendicitis in children
Submitted on 04 Nov 2020
Author(s): Miloš Parović, David Selwyn, Sanja Besarović, David Horton
Affiliations: Hull University Teaching Hospitals NHS Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 247
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Poster Information
Abstract: Acute appendicitis is the most common paediatric surgical emergency. The diagnosis remains challenging due to high frequency of atypical presentations and difficulty in eliciting clinical signs in children, resulting in delay in diagnosis and complications. (1) American College of Radiology Appropriateness Criteria suggest abdominal ultrasound scan (US) as the most appropriate initial investigation in suspected appendicitis. (2) Guided by a number of false negative ultrasound scans in our department as well as trying to reduce the number of unnecessary surgeries during the COVID-19 pandemic, we conducted a retrospective clinical audit to evaluate the usefulness of US scanning in diagnosis of acute appendicitis. The standards for diagnosis of acute appendicitis by US were obtained from the literature. (3) The US features suggestive of appendicitis were compared with histological findings to determine: 1) the sensitivity and specificity, 2) positive predictive value (PPV) and negative predictive value (NPV) of US scanning in diagnosis of acute appendicitis in children. US scan was performed in 127 patients, with 21 true positive, 84 true negative, 17 false positive and 5 false negative results. This resulted in sensitivity of 81%, specificity of 83%, PPV of 55% and NPV of 94%. Our findings show that we can confidently rely on negative US scans to exclude the diagnosis of appendicitis. Importantly, this could result in a reduction of unnecessary invasive procedures and shorter hospital stay. Nevertheless, a positive US scan should be used with caution when aiding clinical decision making and should not replace clinical acumen when making a diagnosis.Summary: A single-centre retrospective cohort study which included 127 patients to assess the usefulness of ultrasound scanning in diagnosis of acute appendicitis in children. Our results show the sensitivity of US scan in appendicitis was 81%, specificity 83%, negative predictive value 94% and positive predictive value 55%. The results suggest that we can confidently rely on USS to exclude the diagnosis of appendicitis but a positive scan should be used with caution when making a diagnosis.References: 1) Bundy, et al (2007). Does This Child Have Appendicitis? JAMA : the journal of the American Medical Association, [online] 298(4), pp.438–451
2) Koberlein, G.C., et al. (2019). ACR Appropriateness Criteria® Suspected Appendicitis-Child. Journal of the American College of Radiology, [online] 16(5), pp.S252–S263.
3) Dibble, E.H., et al (2018). Effectiveness of a Staged US and Unenhanced MR Imaging Algorithm in the Diagnosis of Pediatric Appendicitis. Radiology, 286(3), pp.1022–1029.
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