Ultrasonography.
2019 Jan;38(1):67-75. 10.14366/usg.17062.
Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs
- Affiliations
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- 1Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, South Brisbane, Australia. Tristan.Reddan@health.qld.gov.au
- 2Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia.
- 3Hunter Industrial Medicine, Maitland, Australia.
- KMID: 2433294
- DOI: http://doi.org/10.14366/usg.17062
Abstract
- PURPOSE
The purpose of this study was to determine whether the awareness and inclusion of secondary sonographic signs of appendicitis, in combination with a structured evaluation as part of engagement and training for sonographers, improved appendix visualization rates and reduced equivocal findings in children with suspected acute appendicitis.
METHODS
This was a prospective study of 230 children at a tertiary children's hospital in Australia referred for an ultrasound examination of suspected appendicitis. The ultrasound findings, radiology reports, histology, clinical results, and follow-up were collated. Secondary signs were used as an additional assessment of the likelihood of disease where possible, even in the absence of an identified appendix.
RESULTS
The implementation of a structured evaluation as part of sonographer engagement and training resulted in a 28% improvement in appendix visualization (68.7%) compared with a prior retrospective study in a similar population (40.7%). The diagnostic accuracy was 91.7%, with likelihood ratios suggesting a meaningful influence of the pre-test probability of appendicitis in children studied (positive likelihood ratio, 11.22; negative likelihood ratio, 0.09.). Only 7.8% of the findings were equivocal. A binary 6-mm diameter cut-off did not account for equivocal cases, particularly lymphoid hyperplasia.
CONCLUSION
Engagement of sonographers performing pediatric appendiceal ultrasound through training in the scanning technique and awareness of secondary signs significantly improved the visualization rate and provided more meaningful findings to referrers.
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