The non-diagnostic ultrasound in appendicitis: Is a non-visualized appendix the same as a negative study?

Brian Cohen, Jordan Bowling, Peter Midulla, Edward Shlasko, Neil Lester, Henrietta Rosenberg, Aaron Lipskar

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


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.

Original languageEnglish
Pages (from-to)923-927
Number of pages5
JournalJournal of Pediatric Surgery
Issue number6
StatePublished - 1 Jun 2015


  • Abdominal ultrasound
  • Appendicitis
  • Negative predictive value
  • Non-diagnostic ultrasound


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