Although CT is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is nearly as good in experienced hands. Since ultrasound will reduce radiation exposure, ultrasound is the preferred initial imaging examination in children. If the results of the ultrasound exam are equivocal, it may be followed by CT. This approach is cost-effective, reduces potential radiation risks and has excellent accuracy, with reported sensitivity and specificity of 94 percent.

Conditions: Actute Appendicitis

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

Sources

• Adibe OO, Amin SR, Hansen EN, Chong AJ, Perger L, Keijzer R, et al. An evidence-based clinical protocol for diagnosis of acute appendicitis decreased the use of computed tomography in children. J Pediatr Surg. 2011 Jan;46(1):192-6. (PubMed)
• American College of Radiology. Five things physicians and patients should question. 2013 [cited 2014 Mar 12]. (ChoosingWisely)
• Bachur RG, Dayan PS, Bajaj L, Macias CG, Mittal MK, Stevenson MD, et al. The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis. Ann Emerg Med. 2012 Nov;60(5):582,590.e3. (PubMed)
• Bachur RG, Hennelly K, Callahan MJ, Chen C, Monuteaux MC. Diagnostic imaging and negative appendectomy rates in children: Effects of age and gender. Pediatrics. 2012 May;129(5):877-84. (PubMed)
• Bachur RG, Hennelly K, Callahan MJ, Monuteaux MC. Advanced radiologic imaging for pediatric appendicitis, 2005-2009: Trends and outcomes. J Pediatr. 2012 Jun;160(6):1034-8. (PubMed)
• Burr A, Renaud EJ, Manno M, Makris J, Cooley E, DeRoss A, et al. Glowing in the dark: Time of day as a determinant of radiographic imaging in the evaluation of abdominal pain in children. J Pediatr Surg. 2011 Jan;46(1):188-91. (PubMed)
• 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)
• Park JS, Jeong JH, Lee JI, Lee JH, Park JK, Moon HJ. Accuracies of diagnostic methods for acute appendicitis. Am Surg. 2013 Jan;79(1):101-6. (PubMed)
• Ramarajan N, Krishnamoorthi R, Barth R, Ghanouni P, Mueller C, Dannenburg B, et al. An interdisciplinary initiative to reduce radiation exposure: Evaluation of appendicitis in a pediatric emergency department with clinical assessment supported by a staged ultrasound and computed tomography pathway. Acad Emerg Med. 2009 Nov;16(11):1258-65. (PubMed)
• Santillanes G, Simms S, Gausche-Hill M, Diament M, Putnam B, Renslo R, et al. Prospective evaluation of a clinical practice guideline for diagnosis of appendicitis in children. Acad Emerg Med. 2012 Aug;19(8):886-93. (PubMed)
• Thirumoorthi AS, Fefferman NR, Ginsburg HB, Kuenzler KA, Tomita SS. Managing radiation exposure in children--reexamining the role of ultrasound in the diagnosis of appendicitis. J Pediatr Surg. 2012 Dec;47(12):2268-72. (PubMed)
• Wan MJ, Krahn M, Ungar WJ, Caku E, Sung L, Medina LS, et al. Acute appendicitis in young children: Cost-effectiveness of US versus CT in diagnosis--a markov decision analytic model. Radiology. 2009 Feb;250(2):378-86. (PubMed)