Utility of ultrasound grading classification in assessing acute appendicitis severity in children

Abstract

Background Accurate assessment of acute appendicitis severity is important for planning treatment. This study aimed to evaluate the utility of ultrasound (US) grading classification in assessing acute appendicitis severity in children. Methods We retrospectively studied pediatric patients diagnosed with acute appendicitis using US. US findings were classified into four grades based on the internal structure, and the clinical findings were compared among them. We also compared the frequency of complicated appendicitis (CA) among US grades in patients who underwent early appendectomy (EA). Results In total, 124 pediatric patients with acute appendicitis were enrolled. The mean age was 11.7 years, and 74 patients were male. Fifty-seven patients were classified as Grade Ⅰ-Ⅱ, and 67 patients were classified as Grade Ⅲ-Ⅳ. Grade III-IV patients were significantly younger, had lower body weights, and longer duration of symptoms than Grade I-II patients. Grade III-IV patients also had significantly higher body temperatures, pediatric appendicitis scores, white blood cell counts, and C-reactive protein levels on admission. In the EA cases, most CA cases were Grade III-IV (90.3%). Conclusions US grading classification may be useful for assessing the severity of acute appendicitis in children and assisting in making treatment decisions.