Ultrasound-based decision making in the treatment of acute appendicitis in children

Abstract

Background/purpose Imaging techniques are used widely to diagnose appendicitis. However, the negative appendectomy rate remains at about 15%. The authors assessed ultrasound-based decision making in the treatment of acute appendicitis in children. Methods The authors prospectively studied 165 consecutive children (3 to 15 years old) evaluated for appendicitis. Diagnosis and treatment were based solely on ultrasound scan findings. Criterion for appendicitis was a diameter exceeding 6 mm. Severity was classified into 4 grades based on the appearance of intramural appendiceal structure. Patients with grades I or II received antibiotic therapy. Patients with grades III or IV underwent appendectomy. Results Ultrasound scan diagnosed appendicitis in 93 children (grade I, 7; grade II, 17; grade III, 41; and grade IV, 28). All but 2 patients with grades I or II underwent antibiotic therapy without complication. All grades III or IV patients underwent appendectomy. There was no negative appendectomy among 76 appendectomies during this period. Ultrasound-based prediction of severity was correct in 67 cases (88%). Ultrasonography identified other pathology in 39. Conclusions Ultrasonography in children cannot only visualize all inflamed appendices but also predict severity of disease. Treatment based entirely on ultrasound scan identified patients who required surgery for severe appendicitis and permitted successful conservative treatment for mild appendicitis.