Ultrasound sufficient for evaluating pediatric appendicitis

AuntMinnie.com | November 5 – Point-of-care ultrasound conducted by emergency medicine physicians may be a useful screening tool for evaluating acute appendicitis in children, according to research from Newark Beth Israel Medical Center in New Jersey.

The research team found that point-of-care ultrasound yielded 85% accuracy for evaluating appendicitis and can be a useful adjunct to clinical evaluation, according to Adam Sivitz, MD, director of pediatric emergency medicine education at Newark Beth Israel Medical Center.

He presented the findings at the American College of Emergency Physicians (ACEP) Research Forum in Las Vegas in September.

Acute appendicitis produces 80,000 cases a year and is the most common abdominal surgical emergency in children. Due to concerns over radiation exposure in children, ultrasound is the recommended first-line imaging modality for evaluating acute appendicitis, Sivitz said.

Sivitz noted that clinical scoring models for ruling out appendicitis have been published to help stage the order of imaging, placing ultrasound before CT.

“However, these models have ignored the obvious trend in emergency medicine to utilize point-of-care ultrasound, which is now part of emergency medicine resident curriculum and even beginning to get taught at the medical school level,” Sivitz toldAuntMinnie.com.

“Many people in [emergency medicine] who regularly do ultrasound have been anecdotally looking at the right lower quadrant, and a few places have published manuscripts or abstracts for this in the adult population,” he said. “We think that children would benefit the most from [right lower quadrant] point-of-care ultrasound because of a more ultrasound-friendly body habitus and the greater risks associated with radiation exposure in childhood.”

Seeking to determine the accuracy of emergency physician bedside ultrasound for suspected appendicitis in children, the research team is conducting a prospective observational study at an urban, academic pediatric emergency department. The study includes patients ages newborn to 21, who presented to the pediatric emergency department with a clinical suspicion for acute appendicitis and had received an order for a radiology ultrasound, CT, or surgical consult.

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