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Abstract
Objective Appendiceal diameter is a primary sonographic determinant of paediatric appendicitis. We sought to determine if the diagnostic performance of outer appendiceal diameter differs based on age or with the addition of secondary sonographic findings.
Methods We retrospectively reviewed patients aged less than 19 years who presented to the Boston Children’s Hospital ED and had an ultrasound (US) for the evaluation of appendicitis between November 2015 and October 2018. Our primary outcome was the presence of appendicitis. We analysed the cases to evaluate the optimal outer appendiceal diameter as a predictor for appendicitis stratified by age (<6, 6 to <11, 11 to <19 years), and with the addition of one or more secondary sonographic findings.
Results Overall, 945 patients met criteria for inclusion, of which 43.9% had appendicitis. Overall, appendiceal diameter as a continuous measure demonstrated excellent test performance across all age groups (area under the curve (AUC) >0.95) but was most predictive of appendicitis in the youngest age group (AUC=0.99 (0.98–1.00)). Although there was no significant difference in optimal diameter threshold between age groups, both 7- and 8-mm thresholds were more predictive than 6 mm across all groups (p<0.001). The addition of individual (particularly appendicolith or echogenic fat) or combinations of secondary sonographic findings increased the diagnostic value for appendicitis above diameter alone.
Conclusions Appendiceal diameter as a continuous measure was more predictive of appendicitis in the youngest group. Across all age groups, the optimal diameter threshold was 7 mm for the diagnosis of paediatric appendicitis. The addition of individual or combination secondary sonographic findings increases diagnostic performance.
- pediatric emergency medicine
- pediatrics
- ultrasonography
- abdomen
Data availability statement
Data are available on reasonable request. Not a clinical trial.
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Data availability statement
Data are available on reasonable request. Not a clinical trial.
Footnotes
Handling editor Shammi L Ramlakhan
Twitter @jeffreytneal
Presented at The abstract of this article was previously accepted and presented as a poster presentation at the Proceedings of the 2021 Pediatric Academic Societies Annual Meeting in May of 2021, which was virtual due to the COVID-19 pandemic.
Contributors JTN and RGB conceived the study, submitted the appropriate institutional review board paperwork and supervised the data collection and analysis. JTN, RGB and CEB undertook acquisition and management of data, including quality control, as well as review of the analysis. CEB provided protocol advice and facilitated acquisition of US data. MCM provided additional protocol advice including statistical recommendations. JTN drafted the manuscript, and RGB takes responsibility for the paper as a whole. All authors contributed substantially to the manuscript review and revision. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. JTN is the guarantor of the manuscript.
Funding This work was supported by the Dr Michael Shannon Emergency Medicine Award (Boston Children’s Hospital) to JTN. Data collection for this study was partially funded by an internal grant, the Dr Michael Shannon Emergency Medicine Award (Boston Children’s Hospital).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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