M. A. Fleming1, D. Grabski1, J. H. Mehaffey1, S. Tocchio2, W. McCullough2, J. Gander3 1University Of Virginia,Department Of Surgery,Charlottesville, VA, Virgin Islands, U.S. 2University Of Virginia,Division Of Pediatric Radiology,Charlottesville, VA, Virgin Islands, U.S. 3University Of Virginia,Division Of Pediatric Surgery,Charlottesville, VA, Virgin Islands, U.S.
Introduction:
Acute appendicitis (AA) is the most common indication for emergency pediatric surgery. Ultrasound (US) is increasingly used to make the diagnosis of appendicitis at dedicated children’s hospitals with technologists/radiologists who exclusively perform US on children. However, many children are still subjected to ionizing radiation via computed tomography (CT) as an initial modality at rural hospitals. Currently, there is no consistent US-based scoring system that reliably aids in the diagnosis of AA. We sought to demonstrate the efficacy of a novel Ultrasound-Appendicitis (US-Appy) Score at a non-free standing children’s hospital.
Methods:
We performed a retrospective analysis of all pediatric patients who underwent an US for suspected AA between October 2015 and October 2016. The imaging findings were graded using our scoring system (see Table) by 2 independent pediatric radiologists. US-Appy Score is comprised of criteria ranging from completely visualized normal appendix (1) to acute appendicitis with abscess (6). We performed a univariate logistic regression to estimate the odds ratio of US-Appy Score in predicting pathologically confirmed appendicitis. A p-value of 0.05 was considered significant.
Results:
A total of 221 patients met inclusion criteria. Univariate logistic regression demonstrated the US-Appy Score is a significant predictor of appendicitis (OR 8.09, 95% CI 4.53-14.48, p<0.0001) with the receiver operator curve demonstrating a c-statistic of 0.930. Ten patients had ancillary inflammatory findings with a score of 4, and 40% of these patients were found to have acute appendicitis. Over 80% of patients with a score of 5 or 6 had pathologically confirmed appendicitis.
Conclusion:
This study establishes that the US-Appy Score can be independently useful in the diagnosis of appendicitis outside of other clinical parameters. Patients with scores of 1 or 2, can be clinically observed or evaluated for an alternative diagnosis while scores of 3 or 4 may be evaluated further with an MRI if clinical suspicion still exists or there are ancillary inflammatory findings. In the correct clinical context, an US-Appy Score of 5 or 6 may be sufficient to proceed to the operating room without additional imaging. This score may encourage the use of US as an initial imaging modality and reduce the need for imaging with CT at most hospitals. We believe that the US-Appy Score can be easily applied at hospitals where US is performed by technologists/radiologists who care for both adult and pediatric patients
