Diagnostic Accuracy of Ultrasonography in Diagnosis of Acute Appendicitis in Pediatric Population
DOI:
https://doi.org/10.70749/ijbr.v3i7.1982Keywords:
Ultrasonography, Acute Appendicitis, Pediatric DiagnosisAbstract
Background: One of the most frequent reasons why children require emergency abdominal surgery is acute appendicitis. In order to avoid problems including perforation, abscess formation, and needless surgery, an accurate and prompt diagnosis is essential. Because it is non-invasive and radiation-free, ultrasound (USG) is commonly utilized as a first imaging modality, particularly for young patients. Objective: The purpose of this study was to compare sonographic findings with intraoperative and histological data in order to assess the diagnostic accuracy of ultrasonography in identifying acute appendicitis in the pediatric population. Methodology: Over the course of six months, a qualitative study was carried out in a tertiary care hospital's emergency room from November 2024 to May 2025. Ultrasonography was performed on 130 children, ages 5 to 18, who had a clinical suspicion of appendicitis. To evaluate sensitivity, specificity, and predictive qualities, USG results were contrasted with surgical and histological results. Results: The results showed that ultrasonography had a 90.2% sensitivity, 57.1% specificity, 88.5% positive predictive value, and 61.5% negative predictive value. Non-compressible tubular structure >6 mm (75.4%) and wall thickening (70.8%) were common sonographic findings. 102 cases (78.5%) had appendicitis confirmed by final diagnosis; the stages included suppurative, gangrenous, and perforated types. Conclusion: Ultrasonography is a safe, dependable, and reasonably priced method for identifying children's acute appendicitis early on. Even if it depends on the operator, it is essential for directing clinical judgements and minimizing needless procedures, especially in environments with limited resources.
Downloads
References
1. Pinto, F., Pinto, A., Russo, A., Coppolino, F., Bracale, R., Fonio, P., Macarini, L., & Giganti, M. (2013). Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: Review of the literature. Critical Ultrasound Journal, 5(S1).
https://doi.org/10.1186/2036-7902-5-s1-s2
2. Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J. H., & Drake, F. T. (2015). Acute appendicitis: Modern understanding of pathogenesis, diagnosis, and management. The Lancet, 386(10000), 1278-1287.
https://doi.org/10.1016/s0140-6736(15)00275-5
3. Yildiz, T., Ilce, Z., Turan, G., Bozdag, Z., & Elmas, B. (2015). Parasites in the etiology of pediatric appendicitis. Turkish Journal of Parasitology, 39(3), 190-193.
https://doi.org/10.5152/tpd.2015.3737
4. Öztaş, T., Dursun, A., Söğütçü, N., & Bilici, S. (2018). Unusual histopathological findings in appendectomy specimens obtained from 1683 pediatric patients with suspected acute appendicitis. Indian Journal of Surgery, 81(4), 344-349.
https://doi.org/10.1007/s12262-018-1814-4
5. Okoro, K. U., De La Espriella, M. G., Grider, D. J., & Baffoe-Bonnie, A. W. (2018). Tuberculous enteritis presenting as acute appendicitis and Perirectal abscess. Case Reports in Medicine, 2018, 1-5.
https://doi.org/10.1155/2018/6068258
6. Almaramhy, H. H. (2017). Acute appendicitis in young children less than 5 years: Review article. Italian Journal of Pediatrics, 43(1).
https://doi.org/10.1186/s13052-017-0335-2
7. Short, H. L., Sarda, S., Travers, C., Hockenberry, J. M., McCarthy, I., & Raval, M. V. (2018). Trends in common surgical procedures at children’s and nonchildren’s hospitals between 2000 and 2009. Journal of Pediatric Surgery, 53(8), 1472-1477.
https://doi.org/10.1016/j.jpedsurg.2017.11.053
8. Blitman, N. M., Anwar, M., Brady, K. B., Taragin, B. H., & Freeman, K. (2015). Value of focused appendicitis ultrasound and Alvarado score in predicting appendicitis in children: Can we reduce the use of CT? American Journal of Roentgenology, 204(6), W707-W712.
https://doi.org/10.2214/ajr.14.13212
9. Dilley, A., Wesson, D., Munden, M., Hicks, J., Brandt, M., Minifee, P., & Nuchtern, J. (2001). The impact of ultrasound examinations on the management of children with suspected appendicitis: A 3-year analysis. Journal of Pediatric Surgery, 36(2), 303-308.
https://doi.org/10.1053/jpsu.2001.20702
10. Kaiser, S., Jorulf, H., Söderman, E., & Frenckner, B. (2004). Impact of radiologic imaging on the surgical decision-making process in suspected appendicitis in children1. Academic Radiology, 11(9), 971-979.
https://doi.org/10.1016/j.acra.2004.05.023
11. Bachur, R. G., Dayan, P. S., Bajaj, L., Macias, C. G., Mittal, M. K., Stevenson, M. D., Dudley, N. C., Sinclair, K., Bennett, J., Monuteaux, M. C., & Kharbanda, A. B. (2012). The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis. Annals of Emergency Medicine, 60(5), 582-590.e3.
https://doi.org/10.1016/j.annemergmed.2012.05.034
12. Erikci, V. S. (2018). Management of pediatric appendicitis. Current Issues in the Diagnostics and Treatment of Acute Appendicitis.
https://doi.org/10.5772/intechopen.72793
13. Alvarado, A. (2018). Clinical approach in the diagnosis of acute appendicitis. Current Issues in the Diagnostics and Treatment of Acute Appendicitis.
https://doi.org/10.5772/intechopen.75530
14. Nielsen, J. W., Boomer, L., Kurtovic, K., Lee, E., Kupzyk, K., Mallory, R., Adler, B., Bates, D. G., & Kenney, B. (2015). Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. Journal of Pediatric Surgery, 50(1), 144-148.
https://doi.org/10.1016/j.jpedsurg.2014.10.033
15. Sauvain, M., Slankamenac, K., Muller, M. K., Wildi, S., Metzger, U., Schmid, W., Wydler, J., Clavien, P., & Hahnloser, D. (2016). Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications. Langenbeck's Archives of Surgery, 401(5), 643-649.
https://doi.org/10.1007/s00423-016-1444-x
16. Boonstra, P. A., Van Veen, R. N., & Stockmann, H. B. (2014). Less negative appendectomies due to imaging in patients with suspected appendicitis. Surgical Endoscopy, 29(8), 2365-2370.
https://doi.org/10.1007/s00464-014-3963-2
17. Kessler, N., Cyteval, C., Gallix, B., Lesnik, A., Blayac, P., Pujol, J., Bruel, J., & Taourel, P. (2004). Appendicitis: Evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology, 230(2), 472-478.
https://doi.org/10.1148/radiol.2302021520
18. Flum, D. R., Morris, A., Koepsell, T., & Dellinger, E. P. (2001). Has misdiagnosis of appendicitis decreased over time? JAMA, 286(14), 1748.
https://doi.org/10.1001/jama.286.14.1748
19. Sauerland, S., Lefering, R., & Neugebauer, E. A. (2004). Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews.
https://doi.org/10.1002/14651858.cd001546.pub2
20. Guller, U., Hervey, S., Purves, H., Muhlbaier, L. H., Peterson, E. D., Eubanks, S., & Pietrobon, R. (2004). Laparoscopic versus open appendectomy. Annals of Surgery, 239(1), 43-52.
https://doi.org/10.1097/01.sla.0000103071.35986.c1
21. Blomqvist, P. G., Andersson, R. E., Granath, F., Lambe, M. P., & Ekbom, A. R. (2001). Mortality after appendectomy in Sweden, 1987–1996. Annals of Surgery, 233(4), 455-460.
https://doi.org/10.1097/00000658-200104000-00001
22. Vinz, H., & Neu, J. (2007). Malpractice claims relating to the diagnosis and treatment of acute appendicitis--decisions of the Norddeutsche Schlichtungsstelle (Expert Panel for Extrajudicial Claims Resolution of the Medical Associations in Northern Germany). Zeitschrift fur Arztliche Fortbildung und Qualitatssicherung, 101(8), 553-563.
https://doi.org/10.1016/j.zgesun.2007.08.034
23. Benabbas, R., Hanna, M., Shah, J., & Sinert, R. (2017). Diagnostic accuracy of history, physical examination, laboratory tests, and point‐of‐care ultrasound for pediatric acute appendicitis in the emergency department: A systematic review and meta‐analysis. Academic Emergency Medicine, 24(5), 523-551.
https://doi.org/10.1111/acem.13181
24. Doria, A. S., Moineddin, R., Kellenberger, C. J., Epelman, M., Beyene, J., Schuh, S., Babyn, P. S., & Dick, P. T. (2006). US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology, 241(1), 83-94.
https://doi.org/10.1148/radiol.2411050913
25. Trout, A. T., Sanchez, R., Ladino-Torres, M. F., Pai, D. R., & Strouse, P. J. (2012). A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography? Pediatric Radiology, 42(7), 813–823.
https://doi.org/10.1007/s00247-012-2358-6
26. Garcia Peña, B. M., Taylor, G. A., Fishman, S. J., Mandl, K. D. (2016). Effects of an Imaging Protocol on Clinical Outcomes Among Pediatric Patients With Appendicitis. Pediatrics, 138(1), e20154340.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
