Diagnostic accuracy of surgeon performed ultrasound (SPU) for appendicitis in children
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In brief
In brief
Prospective study of 65 children at an Australian tertiary pediatric hospital found surgeon-performed ultrasound (SPU) achieved diagnostic accuracy comparable to radiology-performed ultrasound for appendicitis, with the advantage of earlier completion (median 12h vs 14.15h). Training surgical trainees in point-of-care ultrasound could enable faster diagnosis and treatment decisions in pediatric appendicitis cases.
Written by the GCMD Library team from the article.
Aim
Compare the diagnostic accuracy of surgeon performed ultrasound to radiology performed ultrasound in children presenting with suspected appendicitis to a tertiary care pediatric hospital in Australia.
Methods
Children under 16 presenting to the emergency department of The Children's Hospital at Westmead were considered for the study. Patients with obvious signs of appendicitis not requiring ultrasound and those with established ultrasound diagnosis of appendicitis were excluded. Ultrasound was performed by a Pediatric Surgeon (SPU) after obtaining consent. The treating team was blinded to the results. Patient underwent formal ultrasound in radiology (RPU) and treatment was based on the formal report. SPU result was reviewed by a radiologist blinded to results of RPU. The results were compared.
Results
65 children underwent ultrasound. 35 were male. Median age was 10 (range3–15). Median weight was 36 kg (range 12.6–76.2 kg), z-score median 0.21 (−1.83 to 2.74). Symptom duration ranged from few hours to 2 weeks but majority (45) had symptoms for less than 48 h. Prevalence of appendicitis was 45%. Thirty two underwent surgery. Negative appendicectomy rate was 9.4%. Thirty three did not have surgery. 8 represented but only one proceeded to appendicectomy. SPU was done earlier than RPU (median 12 h vs 14.15 h) p = 0.088. Diagnostic accuracy using ROC did not reveal significant difference.
Conclusion
SPU can be performed earlier than RPU with reliable accuracy. Training surgical trainees will enable early diagnosis and management of appendicitis.