When is ultrasonography recommended in the workup of appendicitis by the ACEP?

Updated: Jul 23, 2018
  • Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

In pediatric patients, the American College of Emergency Physicians (ACEP) 2010 clinical policy update recommends using ultrasonography for confirmation, but not exclusion, of acute appendicitis. To definitively exclude acute appendicitis, CT is recommended. [8, 9]

Ultrasonography followed by magnetic resonance imaging (MRI) appears to be an effective combination for accurately diagnosing appendicitis in children. [49, 50] In a retrospective study of 662 patients younger than age 18 years presenting to the emergency department with abdominal pain, ultrasonography/MRI was performed in 397 patients and CT scanning was used in 265. In the ultrasonography/MRI group, ultrasound was positive for appendicitis in 19.7% of patients, and MRI identified an additional 62 cases, of which 7 (11.3%) were complicated. In the CT group, 55.4% of patients positive for appendicitis, of which 19.4% were complicated. [49, 50]

The false-positive rate was similar in the two groups (1.4% in the ultrasonography/MRI group and 2.5% in the CT group), and there were no false-negatives in either group. [49, 50] No significant differences between groups were observed in mean overall length of hospital stay, time to antibiotic administration, time to appendectomy, or perforation rate. [49, 50]


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