SonoStudies: Ultrasound First for Appendicitis, the gift that keeps on giving….

I know I harp on this quite a bit – or at least Ive been found guilty of doing it, but it’s important, relevant, and radiation /cost saving. Ive spoken about US and appendicitis in a prior post when talking about who we should or should not CT. There have been quite a few studies lately about appendicitis and ultrasound’s role in it’s diagnosis. I trained when it was a “clinical” diagnosis – loved those days – ask them where the pain is, they point to the right lower quadrant, it’s tender there with a fever history, I call the surgeon and they come down and decide whether to observe or take to the OR. I do miss those days, but now we live in a more litiginous world, where surgeons records of missed/false diagnoses are public and the prior accepted 20% false rate for appendicitis no longer exists. CT scans have increased and there are many studies that have shown that we should perform ultrasound for suspected appendicitis first. Save the radiation. Below is the list of the most recent studies in just the last month or two (adding to the many that are already out there). Other options (other than CT, of course) include: discharge with specific return precautions, 1day follow up exam/ US study, admit for 24 hour observation, admit for OR.

Sonography as the First Line of Evaluation in Children with Suspected Acute Appendicitis – in Journal of US in Medicine Aug 2012

Prospective Evaluation of a Clinical Practice Guideline for Diagnosis of Appendicitis in Children – in Academic Emergency Medicine July 31, 2012

The Effect of Abdominal Pain Duration on the Accuracy of Diagnostic Imaging for Pediatric Appendicitis – in Annals of Emergency Medicine July 26, 2012

Imaging and the Use of Scores in the Diagnosis of Appendicitis in Children – in European Journal of Pediatric Surgery June 30, 2012

Surgeon-performed ultrasound at the bedside for the detection of appendicitis and gallstones: systematic review and meta-analysis – in American Journal of Surgery June 28, 2012

Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis – in International Journal of Emergency Medicine June 6, 2012

The Effect of Point-of-care Ultrasonography on Emergency Department Length of Stay and Computed Tomography Utilization in Children With Suspected Appendicitis. – in Academic Emerg Med  Feb 2, 2014

And, in case any of you were wondering what appendicitis looks like on ultrasound: a non-compressible circular structure between the iliac vessels and the psoas muscle that elongates on longitudinal view (the last part differentiates it from a lymph node) that may or may not have a shadowing fecalith:


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