Secondary Signs for Ultrasound Diagnosis of Appendicitis

This is Todd Ponsky with the Journal of Pediatric Surgery, and today we're in Buffalo, New York at the Women and Children's Hospital, Buffalo. And with us today, we have Doctor Ben Tayback, who's the senior pediatric surgery fellow here, and he's gonna present a new article from the Journal of Pediatric Surgery. Thanks, Doctor Fonsky. So, we get a lot of consults for appendicitis these days, and the standard for our hospital now has been to transition to ultrasound as the initial diagnostic method, which is great in reducing the amount of CAT scans that we do. The problem though is a lot of times we get an equivocal ultrasound report from the radiologist and what to do in that situation. So this group from Emory, in a recent article JPS published a study. Secondary signs may improve the diagnostic accuracy of equivocal ultrasounds for suspected appendicitis in children. They reviewed a series of 530 equivocal ultrasounds, and they found that if one of these three signs was present, fluid collection, hyperemia, or an appendicolith, they could diagnose appendicitis with an 88% accuracy rate. So, so Ben, thanks for presenting that paper. What are your thoughts on the paper, and is this gonna change your management? Well, the issue I think is that when you break down this 88% accuracy rate, it has an 89% negative predictive value, but only a 60% positive predictive value. So I think that readers really need to take that into account when they're trying to make that decision that just because one of these signs is present doesn't necessarily mean the patient has appendicitis. Great, thank you.