Abdominal ultrasound often not enough for children with suspected appendicitis

Children presenting with signs of appendicitis should receive careful further evaluation if the usual first-line exam, abdominal ultrasound, fails to deliver a clear view of the vestigial digestive-system organ.

That’s according to the authors of a study showing that more than a few pediatric patients who had a nonvisualized appendix on ultrasound ended up needing intervention for appendicitis.

Pediatric Emergency Care published the study online Nov. 12.

Kristy Williamson, MD, of Cohen Children’s Medical Center in New Hyde Park, New York, and co-authors reviewed charts of more than 3,200 children who were imaged with abdominal ultrasound in their ER over a two-year period.

In more than half the cases, 54 percent, the appendix was not inspectable on ultrasound.

Appendicitis was subsequently diagnosed in a total of 28 percent of all the patients, including in 11.9 percent with an appendix not visualized on ultrasound.

Among patients whose ER physicians ordered follow-up studies during the same visit, 21.2 percent had appendicitis.

And of the children discharged without a diagnosis, 1.5 percent were later found to have appendicitis, the main clinical symptoms of which are belly pain, low-grade fever and nausea.

“A significant proportion of patients with suspected appendicitis who had an initial nonvisualized appendix on ultrasound were ultimately diagnosed with appendicitis,” Williamson et al. conclude. “Clinicians must be vigilant about pursuing a definitive diagnosis if an initial ultrasound is nondiagnostic.”