Can Ultrasound Spot the Culprit - Evaluating the Effectiveness of Ultrasonography in Precisely Diagnosing Acute Appendicitis in Children

Introduction: Acute appendicitis is a common surgical emergency in children, often requiring imaging for confirmation due to diverse presentations. While computed tomography scan is favored in many centers for its sensitivity, it comes with radiation exposure and higher costs. Ultrasonography, being radiation-free and cost-effective, is gaining popularity, especially in pediatric cases. However, its reported accuracy varies in the literature. This study aims to evaluate the diagnostic accuracy of ultrasonography in pediatric appendicitis cases and to determine its precision in distinguishing between simple and complicated cases of appendicitis.

Materials and methods: A retrospective analysis was conducted on children with suspected appendicitis who presented to the department of pediatric surgery. All patients underwent ultrasonography followed by appendicectomy based on considered clinical decision. Ultrasonography findings were compared with intraoperative observations categorized as uncomplicated or complicated appendicitis.

Results: Among 152 patients, ultrasonography accurately diagnosed appendicitis in 94.6% of cases, with 5.38% having nonvisualized appendices. In our group, the sensitivity and specificity of ultrasound to detect appendicitis were 94.62% and 95.65%, respectively. The diagnostic accuracy of the test is 95.63%. However, in our study, the sensitivity of the ultrasonography to correctly identify if it is a simple or complicated appendicitis was only 54.9% but had a specificity of 98.7%. Thus, ultrasonography showed a much lower sensitivity (54.9%) in distinguishing between simple and complicated appendicitis.

Conclusion: Ultrasonography demonstrates high sensitivity and specificity in diagnosing pediatric appendicitis, making it a promising preoperative investigation. However, it may not accurately differentiate between simple and complicated cases. A comprehensive approach involving clinical and laboratory parameters alongside secondary imaging may be necessary for accurate diagnosis, especially in cases of perforated appendicitis.