The importance of visualization of appendix on abdominal ultrasound for the diagnosis of appendicitis in children: A quality assessment review

doi:10.5847/wjem.j.1920-8642.2020.03.002

Abstract

Abstract:

BACKGROUND: Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children. The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.

METHODS: A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years. Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.

RESULTS: Data from two community hospitals indicated visualization rate of the appendix as 11.0% and 23.2% for site 1 and site 2 respectively. In cases where the ultrasound was repeated the visualization rate remains the same. A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis. The results revealed that the visualization of an appendix (P=0.52), significantly improved the diagnosis of appendicitis (z=34, P<0.001).

CONCLUSION: Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis. In our study, we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound. Hence, the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.

Key words: Abdominal ultrasound, Visualization, Importance, Appendix, Abdominal pain, Acute appendicitis, Children, Paediatric population

Muhammad Akhter Hamid, Ruqiya Afroz, Uqba Nawaz Ahmed, Aneela Bawani, Dilnasheen Khan, Rabia Shahab, Asim Salim. The importance of visualization of appendix on abdominal ultrasound for the diagnosis of appendicitis in children: A quality assessment review[J]. World Journal of Emergency Medicine, 2020, 11(3): 140-144.

Figures/Tables 3

References 26

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Initial ultrasound	Site 1	Site 2
Total number of ultrasound performed	1,386	1,167
Number of appendices visualized	153	271
Normal appendix on ultrasound	60	135
Appendicitis on ultrasound	93	137
Visualization rate	11.0%	23.2%

Repeat ultrasound	Site 1	Site 2
Total number of ultrasound performed	15	13
Number of appendices visualized	3	3
Normal appendix on ultrasound	0	2
Appendicitis on ultrasound	3	1
Visualization rate	20.0%	23.1%

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