Healthcare workers normally order an ultrasound scans to look for evidence of appendicitis in children with acute abdominal pain. But these scans don’t always lead to a definitive conclusion about the presence or absence of appendicitis.


Worryingly, a radiologist in a Boston Children's Hospital study, could not identify a normal appendix or any evidence of appendicitis on sonogram in more than half of all patients with suspected appendicitis. Unfortunately, this is not uncommon in children, and it has been reported at other hospitals that also routinely evaluate children with abdominal pain.


The researchers from Boston Children's Hospital retrospectively examined major categories of ultrasound findings in children with suspected appendicitis in conjunction with blood tests that signal bacterial infection in 845 children seen in the emergency department between 2010 and 2012.


It is believed to be the one of the first studies to show that the addition of the white blood count (WBC) and polymorphonuclear leukocyte differential (PMN%) data can significantly improve the clinical value of ultrasound in diagnosing appendicitis in children, according to the study authors.


According to lead study author and pediatric surgeon Shawn J. Rangel, MD: "Ninety percent of all hospitals perform laboratory studies and ultrasound when there is a reasonable suspicion of appendicitis in children. Hospitals tend to look at the results of these studies independently, however, and the improved diagnostic value of using these in a complimentary fashion has not yet been reported. The diagnostic evaluation approach in this study can be used by other institutions as a diagnostic tool to help emergency department physicians and surgeons provide better care by avoiding treatment delay in very high-risk patients and unnecessary admissions for very low risk patients." 


Dr Rangel added: "We are not advocating that other hospitals adopt our sonographic categories or laboratory value cut-offs for WBC and PMN values, but rather to work collaboratively with their radiologists and emergency room physicians to develop their own approach for categorizing sonographic findings in their patients with suspected appendicitis, and then develop risk profiles that are tailor-made for their patients after incorporation of their institution's laboratory data. Institutions can use the risk profiles as educational vehicles and clinical guidelines decision tools to help emergency department physicians and surgeons avoid unnecessary computed tomography (CT) scans and admissions for observation for very low-risk patients, and avoid treatment delays in very high-risk patients."


The new tests can improve the ability of emergency department physicians and pediatric surgeons to identify those patients who should be sent to the operating room for prompt removal of an inflamed appendix, those who may be admitted for observation and those who may safely be discharged home.