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Abdominal ultrasound in the diagnosis of childhood appendicitis
  1. Rob Williams,
  2. Kevin Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

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Report by Rob Williams, Specialist Registrar Search checked by Kevin Mackway-Jones, Consultant

Clinical scenario

An 8 year old patient presents to the emergency department with a six hour history of right iliac fossa pain; examination is suggestive of acute appendicitis. You wonder whether an ultrasound scan would be helpful for diagnosis.

Three part question

In [a paediatric patient with clinical signs of appendicitis] how [useful is an ultrasound scan] at [confirming or refuting the diagnosis]?

Search strategy

Medline 1966–12/00 using the OVID interface. {[(exp child OR children.mp OR exp pediatrics OR pediatric.mp OR paediatric.mp) AND (exp appendicitis OR acute appendicitis.mp)] AND (exp ultrasonography OR ultrasonography.mp OR exp ultrasonics OR ultrasonics.mp OR ultrasound.mp)} LIMIT to human AND english.

Search outcome

Altogether 173 papers found of which 170 were irrelevant or of insufficient quality. The remaining three papers are shown in table 5.

Table 5

Comments

These studies show that ultrasound has a high sensitivity and specificity for the diagnosis of appendicitis. While specificity is high enough to SpIn, sensitivity is too low to SnOut. Further work investigating the diagnostic utility in high, moderate and low risk groups is warranted.

Clinical bottom line

A positive ultrasound is highly specific and can be used to rule in acute appendicitis in children. Sensitivity of this test is too low to rule out the diagnosis.

Report by Rob Williams, Specialist Registrar Search checked by Kevin Mackway-Jones, Consultant

References

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