Pediatric Ultrasound Appendicitis Score for the Diagnosis of Acute Appendicitis to Reduce Computed Tomography Scan Utilization

Abstract

Background Acute appendicitis is one of the most common reasons for pediatric surgical consultation in the emergency room. Although acute appendicitis is a clinical diagnosis, the use of imaging in the emergency department to assist with the diagnosis is very common. Ultrasound is frequently utilized in pediatrics because of the radiation risks associated with computed tomography (CT) scan. The risks of radiation in the pediatric population are much more significant than in adults. Reasons for this include smaller size so there is a relative higher radiation dose than for larger adults, radiosensitive organs such as thyroid, bone marrow, and gonads, and radiation exposure earlier in life allows for more time that a radiation induced cancer could develop. The risks of radiation from imaging are increased with cumulative dosing. Methods The purpose of this study was to incorporate the pediatric appendicitis score (PAS) and standardized ultrasound scoring system to provide a combined score that would assist with the clinical diagnosis of acute appendicitis and avoid the need for a CT scan. Results The presented data shows that for scores of 7 or more, the specificity and sensitivity is 90% and 90.2%, respectively for the diagnosis of acute appendicitis. Discussion This study validates the combined score, shows the specific cutoffs, and initiates the discussion that CT scan may not always be required for diagnosing acute appendicitis if this scoring system is used.