Appendicitis but Not Appendicitis; Utility of Ultrasound in Management of Children with Suspected Appendicitis

Caleb Loo, Pourya Pouryahya

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Objective: Undifferentiated abdominal pain in children is a common presentation to Emergency Department (ED). Diagnostic imaging, in particular, ultrasound, in addition to laboratory tests is often used in this cohort. This study aims to assess the utility of ultrasound in suspected appendicitis in management options. Methods: A 5-year retrospective cross-sectional data analysis of children under the age of 16 presented to Monash Health EDs with abdominal pain between June 2014 and June 2019 was conducted. Among 271934 (total) presentations, 20934 presented with abdominal pain (traumatic and non-traumatic) and 1131 patients were highly suspected for appendicitis who were investigated in ED or hospitalised for ongoing investigation and management. Results: 162 (14.3%; 95% CI, 12.3-16.4) patients had ultrasound findings suggestive of appendicitis, with a further 147 (13.0%; 95% CI, 11.0-15.0) admitted to paediatric surgical ward. 111 (9.81%; 95% CI, 8.1-11.5) patients subsequent underwent diagnostic laparoscopy during their admission which 109 (9.63%; 95% CI, 7.9- 11.4) confirmed intraoperative appendicitis. The mean appendix size difference in patients discharged vs admitted and cases that underwent diagnostic laparoscopy vs conservative management were 0.576mm (95% CI, -1.16-2.32). and 0.217 (95% CI, -1.03-1.47) respectively. Given that the P values of the differences are 0.513 and 0.732 respectively (P>0.05), the results are not statistically significant. Conclusions: The appendix size on ultrasound did not show any correlation with the actual pathology or management option. Clinical picture and clinician’s judgement were the main factors in determining management.
Original languageEnglish
Article number105
Number of pages7
JournalJournal of Universal Surgery and Emergency Medicine
Issue number1
Publication statusPublished - 28 Jul 2020

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