Ultrasound as a first-line imaging tool in paediatric appendicitis: diagnostic yield and limitations
DOI:
https://doi.org/10.18203/2349-3291.ijcp20260082Keywords:
Diagnostic accuracy, Paediatric appendicitis, UltrasonographyAbstract
Background: Acute appendicitis remains a common and clinically significant cause of abdominal pain in children and despite widespread use of ultrasound as the preferred first-line imaging modality, its diagnostic performance continues to show variability across different clinical settings due to factors such as operator dependence and appendix visualization rates. The purpose of the study is to evaluate the diagnostic yield and limitations of ultrasound as a first-line imaging modality in children with suspected acute appendicitis.
Methods: This prospective observational study at the Department of Radiology and Imaging, Bangladesh Shishu hospital and institute, Bangladesh (June 2023–July 2024) included 100 pediatric patients with suspected appendicitis. All underwent abdominal ultrasound and final diagnosis was confirmed by surgery, histopathology or clinical follow-up. Diagnostic performance was calculated using 2×2 tables and analyzed with SPSS 25.0.
Results: The study included 100 pediatric patients (mean age 10.27±3.33 years), with 58% males. The appendix was visualized on ultrasound in 78% of cases; 55% showed features suggestive of appendicitis and 23% appeared normal. Acute appendicitis was confirmed in 60% of patients. Ultrasound yielded 52 true positives, 35 true negatives, 8 false negatives and 5 false positives, resulting in a sensitivity of 86.7%, specificity of 87.5%, positive predictive value of 91.2%, negative predictive value of 81.4% and an overall diagnostic accuracy of 87.0%.
Conclusions: Ultrasound is a reliable first-line imaging tool for pediatric appendicitis, effectively identifying most cases while minimizing the need for invasive or radiation-based investigations.
Metrics
References
Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. American J Epidemiol. 1990;132(5):910-25. DOI: https://doi.org/10.1093/oxfordjournals.aje.a115734
Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis. JAMA. 2007;298(4):438-51. DOI: https://doi.org/10.1001/jama.298.4.438
Kwon JH, Koh SJ, Kim W, Jung YJ, Kim JW, Kim BG, et al. Mortality associated with proton pump inhibitors in cirrhotic patients with spontaneous bacterial peritonitis. J Gastroenterol Hepatol. 2014;29(4):775-81. DOI: https://doi.org/10.1111/jgh.12426
Hobbs JM. Diagnostic imaging of appendicitis with supplementation by transabdominal and transvaginal sonography. J Diagnos Med Sonog. 2015;31(6):345-51. DOI: https://doi.org/10.1177/8756479315611656
Matthew Fields J, Davis J, Alsup C, Bates A, Au A, Adhikari S, et al. Accuracy of point‐of‐care ultrasonography for diagnosing acute appendicitis: a systematic review and meta‐analysis. Acad Emerg Med. 2017;24(9):1124-36. DOI: https://doi.org/10.1111/acem.13212
Becker T, Kharbanda A, Bachur R. Atypical clinical features of pediatric appendicitis. Aca Emerg Med. 2007;14(2):124-9. DOI: https://doi.org/10.1197/j.aem.2006.08.009
Becker C, Kharbanda A. Acute appendicitis in pediatric patients: an evidence-based review. Pediatric Emerg Med Pract. 2019;2;16(9):1-20.
Brenner DJ, Hall EJ. Computed tomography—an increasing source of radiation exposure. New England J Med. 2007;29;357(22):2277-84. DOI: https://doi.org/10.1056/NEJMra072149
Smith MP, Katz DS, Lalani T, Carucci LR, Cash BD, Kim DH, et al. ACR Appropriateness Criteria® right lower quadrant pain suspected appendicitis. Ultras Quart. 2015;1;31(2):85-91. DOI: https://doi.org/10.1097/RUQ.0000000000000118
Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A, et al. Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics. 2014;133(4):586-93. DOI: https://doi.org/10.1542/peds.2013-2128
Acheson J, Banerjee J. Management of suspected appendicitis in children. Arch Dis Childhood-Edu Pract. 2010;95(1):9-13. DOI: https://doi.org/10.1136/adc.2009.168468
ANG A, Chong NK, DANEMAN A. Pediatric appendicitis in “real-time”: the value of sonography in diagnosis and treatment. Ped Emerg Care. 2001;17(5):334-40. DOI: https://doi.org/10.1097/00006565-200110000-00004
Vignault F, Filiatrault D, Brandt ML, Garel L, Grignon A, Ouimet A. Acute appendicitis in children: evaluation with US. Radiology. 1990;176(2):501-4. DOI: https://doi.org/10.1148/radiology.176.2.2195594
Chiegwu HU, Ugwuanyi DC, Udoh BE, Chianumba FS. Evaluation of the diagnostic yield of ultrasound in the management of appendicitis: An experience in a tertiary hospital in South-Eastern Nigeria. West African J Radiol. 2021;28(2):36-41. DOI: https://doi.org/10.4103/wajr.wajr_17_20
Rubin SZ, Martin DJ. Ultrasonography in the management of possible appendicitis in childhood. J Pediat Surg. 1990;25(7):737-40. DOI: https://doi.org/10.1016/S0022-3468(05)80008-9
Hahn HB, Hoepner FU, Kalle T, Macdonald EB, Prantl F, Spitzer IM, et al. Sonography of acute appendicitis in children: 7 years’ experience. Pediatric Radiol. 1998;28(3):147-51. DOI: https://doi.org/10.1007/s002470050316
Lessin MS, Chan M, Catallozzi M, Gilchrist BF, Richards C, Manera L, et al. Selective use of ultrasonography for acute appendicitis in children. The American J Surg. 1999;177(3):193-6. DOI: https://doi.org/10.1016/S0002-9610(99)00002-1
Sivit CJ, Newman KD, Boenning DA, Nussbaum-Blask AR, Bulas DI, Bond SJ, et al. Appendicitis: usefulness of US in diagnosis in a pediatric population. Radiology. 1992;185(2):549-52. DOI: https://doi.org/10.1148/radiology.185.2.1410371
Orr RK, Porter D, Hartman D. Ultrasonography to evaluate adults for appendicitis: decision making based on meta‐analysis and probabilistic reasoning. Academic Emerg Med. 1995;2(7):644-50. DOI: https://doi.org/10.1111/j.1553-2712.1995.tb03606.x
Crady SK, Jones JS, Wyn T, Luttenton CR. Clinical validity of ultrasound in children with suspected appendicitis. Ann Emerg Med. 1993;22(7):1125-9. DOI: https://doi.org/10.1016/S0196-0644(05)80976-X
Pohl D, Golub R, Schwartz GE, Stein HD. Appendiceal ultrasonography performed by nonradiologists: does it help in the diagnostic process. J Ultras Med. 1998;17(4):217-21. DOI: https://doi.org/10.7863/jum.1998.17.4.217
Löfvenberg F, Salö M. Ultrasound for appendicitis: performance and integration with clinical parameters. BioMed research international. 2016;20(1):5697692. DOI: https://doi.org/10.1155/2016/5697692
Fujii Y, Hata J, Futagami K, Hamada T, Mitsuoka H, Teramen K, et al. Ultrasonography improves diagnostic accuracy of acute appendicitis and provides cost savings to hospitals in Japan. J Ultras Med. 2000;19(6):409-14. DOI: https://doi.org/10.7863/jum.2000.19.6.409
Trout AT, Towbin AJ, Fierke SR, Zhang B, Larson DB. Appendiceal diameter as a predictor of appendicitis in children: improved diagnosis with three diagnostic categories derived from a logistic predictive model. European radiology. 2015;25(8):2231-8. DOI: https://doi.org/10.1007/s00330-015-3639-x
Pedram A, Asadian F, Roshan N. Diagnostic Accuracy of Abdominal Ultrasonography in Pediatric Acute Appendicitis. Bull Emerg Trauma. 2019;7(3):278-83. DOI: https://doi.org/10.29252/beat-070311
Gilligan LA, Trout AT, Davenport MS, Zhang B, O'Hara SM, Dillman JR. Predictors of Clinical Outcomes in Pediatric Appendicitis: Role of the Individual Sonographer and Radiologist When Using a First-Line Ultrasound Approach. J Am Coll Radiol. 2021;18(8):1128-38. DOI: https://doi.org/10.1016/j.jacr.2021.03.026
Hajalioghli P, Mostafavi S, Mirza-Aghazadeh-Attari M. Ultrasonography in diagnosis of appendicitis and its complications in pediatric patients: a cross-sectional study. Ann Pediatr Surg. 2020;5;16(1):6723. DOI: https://doi.org/10.1186/s43159-020-00023-1
Reddan T, Corness J, Mengersen K, Harden F. Sonographic diagnosis of acute appendicitis in children: a 3‐year retrospective. Sonography. 2016;3(3):87-94. DOI: https://doi.org/10.1002/sono.12068
Pop GN, Costea FO, Lungeanu D, Iacob ER, Popoiu CM. Ultrasonographic findings of child acute appendicitis incorporated into a scoring system. Singapore Med J. 2022;63(1):35-41. DOI: https://doi.org/10.11622/smedj.2020102
Kaymakci A, Guven S, Erdogan S, Ciftci I, Gokcan R. Evaluation of clinical and imaging findings in children with diagnosis of acute appendicitis. Iranian Journal of Pediatrics. 2017;1;27(4):10095. DOI: https://doi.org/10.5812/ijp.10095
Aman F, Rehman R, Gul S, Panezai M, Bashir S, Sarwar R. Diagnostic Accuracy of Ultrasonography in Diagnosis of Acute Appendicitis in Pediatric Population. Indus J Bios Res. 2025;3(7):516-20. DOI: https://doi.org/10.70749/ijbr.v3i7.1982
Palhapati D, Hudge SB. Ultrasonography as a diagnostic tool for appendicitis in paediatric patients. EAS J Radiol Imaging Technol. 2020;2(6):148-53.
Jangid DH. Role of ultrasound in diagnosing acute appendicitis in pediatric patients. JPTCP. 2022;2:238–55. DOI: https://doi.org/10.53555/kng6by35
Oh SK. Diagnostic Accuracy of Non-Radiologist-Performed Ultrasound for Diagnosing Acute Appendicitis in Pediatric Patients: A Systematic Review and Meta-Analysis. Medicina. 2025;61(7):1308. DOI: https://doi.org/10.3390/medicina61071308
Balbo S, Pini CM, Raffaldi I, Delmonaco AG, Castagno E, Guanà R, et al. Accuracy of point-of-care ultrasound in the diagnosis of acute appendicitis in a pediatric emergency department. J Clin Ultrasound. 2024;52(5):485-90. DOI: https://doi.org/10.1002/jcu.23658
Downloads
Published
How to Cite
Issue
Section
