TY - JOUR
T1 - The non-diagnostic ultrasound in appendicitis
T2 - Is a non-visualized appendix the same as a negative study?
AU - Cohen, Brian
AU - Bowling, Jordan
AU - Midulla, Peter
AU - Shlasko, Edward
AU - Lester, Neil
AU - Rosenberg, Henrietta
AU - Lipskar, Aaron
N1 - Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2015/6/1
Y1 - 2015/6/1
N2 - Purpose The purpose of this retrospective study was to investigate outcomes in children who underwent a non-diagnostic ultrasound (US) evaluating for appendicitis and to identify predictors of a negative diagnosis. Methods An IRB-approved retrospective chart review was performed on patients age 0-18, who underwent an abdominal US evaluating for acute appendicitis from 2004 through 2013. Clinical data and specified outcomes were recorded, and exams were categorized into non-diagnostic studies and further separated into studies where the appendix was non-visualized. Results Of the 1383 studies included for analysis, 876 were non-diagnostic for acute appendicitis (63.34%) with 777 specifically because the appendix was non-visualized. Seven hundred forty of the 876 non-diagnostic studies and 671 of the 777 non-visualized studies were ultimately considered true negatives, corresponding to a negative predictive value (NPV) of 84.47 and 86.36%, respectively. In patients with WBC < 7.5 × 109/L, the NPV of non-diagnostic and non-visualized studies increased to 97.12 and 98.86%, respectively. Patients with WBC < 11.0 × 109/L have similarly high NPVs of 95.59 and 96.99% (non-diagnostic and non-visualized). Conclusion Based on the high NPV of a non-diagnostic US in children without leukocytosis, these patients may safely avoid further diagnostic imaging for the workup of suspected appendicitis.
AB - Purpose The purpose of this retrospective study was to investigate outcomes in children who underwent a non-diagnostic ultrasound (US) evaluating for appendicitis and to identify predictors of a negative diagnosis. Methods An IRB-approved retrospective chart review was performed on patients age 0-18, who underwent an abdominal US evaluating for acute appendicitis from 2004 through 2013. Clinical data and specified outcomes were recorded, and exams were categorized into non-diagnostic studies and further separated into studies where the appendix was non-visualized. Results Of the 1383 studies included for analysis, 876 were non-diagnostic for acute appendicitis (63.34%) with 777 specifically because the appendix was non-visualized. Seven hundred forty of the 876 non-diagnostic studies and 671 of the 777 non-visualized studies were ultimately considered true negatives, corresponding to a negative predictive value (NPV) of 84.47 and 86.36%, respectively. In patients with WBC < 7.5 × 109/L, the NPV of non-diagnostic and non-visualized studies increased to 97.12 and 98.86%, respectively. Patients with WBC < 11.0 × 109/L have similarly high NPVs of 95.59 and 96.99% (non-diagnostic and non-visualized). Conclusion Based on the high NPV of a non-diagnostic US in children without leukocytosis, these patients may safely avoid further diagnostic imaging for the workup of suspected appendicitis.
KW - Abdominal ultrasound
KW - Appendicitis
KW - Negative predictive value
KW - Non-diagnostic ultrasound
UR - http://www.scopus.com/inward/record.url?scp=84929513922&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2015.03.012
DO - 10.1016/j.jpedsurg.2015.03.012
M3 - Article
C2 - 25841283
AN - SCOPUS:84929513922
SN - 0022-3468
VL - 50
SP - 923
EP - 927
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 6
ER -