# Repeat ultrasound in pediatric EDs improves appendicitis diagnosis after referral imaging

## TL;DR

Repeat ultrasound in pediatric emergency departments improves the accuracy of diagnosing appendicitis compared to general emergency departments.

## Contribution

The study demonstrates that pediatric ED ultrasound has higher sensitivity and fewer diagnostic uncertainties than general ED ultrasound for appendicitis.

## Key findings

- Pediatric ED ultrasound showed 85.2% sensitivity versus 51.9% in referring EDs.
- Repeat imaging in pediatric EDs reduced non-visualized appendices and equivocal findings by 34.4% and 30.5%, respectively.
- Higher white blood cell counts and neutrophil percentages were observed in confirmed appendicitis cases.

## Abstract

Acute appendicitis is a leading cause of surgical emergencies in children, with ultrasound (US) emerging as a preferred diagnostic tool due to its lack of radiation and cost-effectiveness. However, the accuracy of US is highly operator-dependent and may vary between general referring emergency departments (EDs) and specialized pediatric EDs.

To compare the diagnostic sensitivity and specificity of US performed at referring EDs vs. a pediatric ED in identifying acute appendicitis.

A retrospective study analyzed pediatric patients aged <18 years who underwent US at referring EDs and were transferred to a pediatric ED for repeat imaging between July 2018 and July 2023. Data collected included US findings, surgical pathology, white blood cell count, and patient disposition. Sensitivities of the US were calculated and compared between settings.

Among 64 children included, the US at the pediatric ED demonstrated higher sensitivity (85.2%) compared to referring EDs (51.9%) (p = 0.018). Pediatric ED US resulted in fewer non-visualized appendices (a 34.4% reduction) and equivocal findings (a 30.5% reduction). Patients with positive surgical pathology exhibited higher white blood cell counts (mean 17.1) and neutrophil percentages (mean 81.0%). False positive rates were low (6.9%), aligning with published benchmarks.

US performed at pediatric EDs exhibited superior diagnostic accuracy for appendicitis compared to referring EDs, likely due to operator expertise and enhanced imaging protocols. Efforts to standardize training and improve resources at referring EDs may reduce diagnostic disparities and unnecessary interventions.