Although CT is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is nearly as good in experienced hands. Appendicitis may be diagnosed based on physical examination. If imaging is needed, ultrasound (including serial ultrasounds) are the preferred initial modality in children. If the results of the ultrasound exams are equivocal, it may be followed by CT. This approach reduces potential radiation risks and has excellent accuracy, with reported sensitivity and specificity of 94 percent.

Conditions: Appendicitis

Diagnostic Tests: Abdominal Computed Tomography Scan, CT Scanning, Abdominal Ultrasound

Sources

• Krishnamoorthi R, Ramarajan N, Wang NE, Newman B, Rubesova E, Mueller CM, et al. Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: Reducing radiation exposure in the age of ALARA. Radiology. 2011 Apr;259(1):231-9. (PubMed)
• Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, et al. ACR appropriateness criteria® right lower quadrant pain–suspected appendicitis. J Am Coll Radiol. 2011 Nov;8(11):749-55. (PubMed)
• Saito JM, Yan Y, Evashwick TW, Warner BW, Tarr PI. Use and accuracy of diagnostic imaging by hospital type in pediatric appendicitis. Pediatrics. 2013 Jan;131(1):e37-44. (PubMed)
• Schuh S, Chan K, Langer JC, Kulik D, Preto-Zamperlini M, Aswad NA, et al. Properties of serial ultrasound clinical diagnostic pathway in suspected appendicitis and related computed tomography use. Acad Emerg Med. 2015 Apr;22(4):406-14. (PubMed)
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