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Pediatric Surgery International
Published in: Pediatric Surgery International 12/2018

01-12-2018 | Original Article

The non-visualized appendix and secondary signs on ultrasound for pediatric appendicitis in the community hospital setting

Authors: Jenny M. Held, Christian S. McEvoy, Jonathan D. Auten, Stephen L. Foster, Robert L. Ricca

Published in: Pediatric Surgery International | Issue 12/2018

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Abstract

Background

Secondary signs of appendicitis on ultrasound may aid with diagnosis in the setting of a non-visualized appendix (NVA). This role has not been shown in the community hospital setting.

Materials and methods

All right lower quadrant ultrasounds performed in children for clinical suspicion of appendicitis over a 5-year period in a single community hospital were evaluated. Secondary signs of inflammation including free fluid, ileus, fat stranding, abscess, and lymphadenopathy were documented. Patients were followed for 1 year for the primary outcome of appendicitis. These data were analyzed to determine the utility of secondary signs in the diagnosis of acute appendicitis when an NVA is reported.

Results

Six hundred and seventeen ultrasounds were reviewed; 470 of these had an NVA. Of NVAs, 47 (10%) of patients were diagnosed with appendicitis. Sensitivity and specificity of having at least one secondary were 38.3% and 80%, respectively. The positive and negative predictive values of having at least one secondary sign were 17.3% and 92%, respectively.

Conclusion

These data suggest that the absence of secondary signs has a strong negative predictive value for appendicitis in the community hospital setting; however, the full utility of secondary signs may be limited in this setting.
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Metadata
Title
The non-visualized appendix and secondary signs on ultrasound for pediatric appendicitis in the community hospital setting
Authors
Jenny M. Held
Christian S. McEvoy
Jonathan D. Auten
Stephen L. Foster
Robert L. Ricca
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Surgery International / Issue 12/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI
https://doi.org/10.1007/s00383-018-4350-1

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