Point-of-Care Ultrasound Good for Suspected Pediatric Appendicitis

Point-of-care ultrasound can be an effective first-line imaging approach for children with suspected appendicitis, according to a study published in the journal Academic Emergency Medicine.

The role of clinician-performed ultrasonography  for suspected appendicitis is unclear. Researchers from the Mount Sinai School of Medicine in New York City sought to determine the effectiveness of point-of-care (POC) ultrasound in children who present to the emergency room with suspected appendicitis and its effect on emergency department length of stay and CT utilization.

"From an institutional perspective, this is the most common surgical problem that we encounter with children in the emergency department," senior author, James W. Tsung, MD, MPH, said in a release. "CT scans have been the best imaging test for diagnosing appendicitis, but they expose children to radiation, which cumulatively can prove harmful, as increasing numbers of studies have shown." Tsung is an associate professor of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai.

The researchers used a prospective observational convenience sample of 150 children with suspected appendicitis seen consecutively between May 1, 2011, and October 1, 2012, in an urban pediatric emergency department. Outcomes were determined by surgical or pathology report in those found to have appendicitis and three weeks later in patients who were deemed not to have appendicitis. Reviewers were blinded and the time to perform the point-of-care ultrasound and CT scan use was measured. The differences in emergency department length of stay were analyzed by one-way analysis of variance (ANOVA) between patients who received dispositions after point-of-care ultrasound, radiology ultrasound, or CT.

Fifty of the 150 enrolled patients had appendicitis (33.3 percent). The three-week follow-up call for the discharged patients did not detect any missed cases of appendicitis. There were no negative laparotomies in those who underwent surgery.

The emergency department length of stay declined by 2 hours and 14 minutes (a 46 percent decrease) for those requiring radiology department ultrasound and nearly 6 hours (a 68 percent decrease) for those requiring CT scan when point-of-care ultrasound was inconclusive as a first-line imaging study.

Baseline CT rate was 44.2 percent prior to study start and decreased to 27.3 percent during the study. CT imaging was avoided in four patients with conclusive point-of-care ultrasound results and inconclusive radiology US results.

"Surgeons are becoming more comfortable using ultrasound for decision-making and that is a big change from reliance on CT scans," said Tsung.

The authors concluded that using this point-of-care approach with ultrasound for children with suspected appendicitis provided high specificity to rule in appendicitis, similar to radiology ultrasound.