A Retrospective Study to Assess the Clinical Benefit of Ultrasound Scans Alone in the Diagnosis of Acute Appendicitis With Normal Biochemical Findings

Introduction Acute appendicitis can affect patients of any age, although it is uncommon in the extremes of age. Timely diagnosis and management of acute appendicitis can have a significant positive effect on both patient care and the local population's wider health. A variety of different imaging modalities exists to investigate possible appendicitis including ultrasound (US) scan, computed tomography (CT) scan, and magnetic resonance imaging (MRI). However, clinicians are at risk of overreliance on radiology alone, rather than clinical history and examination findings, to make a diagnosis. Method A team at a district general hospital (DGH) within the United Kingdom carried out a retrospective, single-centre audit over a three-month period using a general surgical handover list to collate data. The aim of the audit was to assess the value US added when reviewing paediatric patients for suspected appendicitis if biochemical results and clinical findings were within normal parameters. Results Following the exclusion of inappropriate patients, 76 patients were incorporated in the data collection process. Of those patients reviewed, eight (11%) of the population had a positive diagnosis of appendicitis, zero (0%) of which had positive US results. Fifty-three patients (70%) had negative US findings, and 23 patients (30%) did not receive a US at all. Fifty-three patients in whom a US was performed (100%) had a negative US as well as normal inflammatory markers (white cell count, C-reactive protein, and neutrophil). Conclusion US alone is not sufficient to rule out appendicitis and should be used when there is a moderate to high degree of clinical suspicion of appendicitis. US should be used, in conjunction with clinical and biochemical evidence, to help confirm a diagnosis of appendicitis only.