Ultrasound Diagnosis of Acute Appendicitis in Pediatrics: A Community Hospital Network Experience

Background Ultrasound has emerged as the preferred initial imaging modality for diagnosing acute appendicitis in children, but most data supporting its use come from academic children's medical centers. The purpose of this investigation is to describe ultrasound utilization for diagnosing acute appendicitis in children at a large community hospital network. Methods This was a multicenter retrospective observational cohort study and chart review of pediatric patients with acute appendicitis diagnosed in the emergency department (ED). The primary outcome of this study was the proportion of patients diagnosed with ultrasound as the sole imaging modality, presented as a population proportion with a 95% confidence interval. Results There were 450 patients included. The mean age was 10 years (range 3-17). Among the 450 patients, there were a total of 713 imaging studies. Only 213 (47.3%) patients had a single imaging test ordered during the ED encounter, and only 52 patients (11.6%) had an ultrasound during the encounter as the only imaging modality. The initial study ordered was a CT scan in 184 (40.9%), an ultrasound in 172 (38.2%), and an X-ray in 94 (20.9%). Sixty-two of 172 (36.0%) ultrasounds were positive for appendicitis. Of the 62 positive studies, 11 (17.7%) had a confirmatory CT scan. Conclusion In this community hospital network, patients had multiple imaging modalities ordered to confirm the diagnosis of acute appendicitis. Less than half had an ultrasound ordered as the initial imaging modality, suggesting its use is not as widespread as academic data may indicate. Despite a positive diagnostic ultrasound, some patients went on to have a confirmatory CT scan, which provides further opportunity to improve.