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Ultrasound Gains In Kids’ Appendicitis Imaging

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Children’s hospitals seem to have begun switching from CT scans to ultrasound to diagnose children suspected of having appendicitis. But that approach may not work well at general hospitals, and the diagnostic accuracy of either scanning method isn’t what it should be.

So concludes a new study by researchers at Washington University School of Medicine in St. Louis. It compared the experiences of patients at St. Louis Children’s Hospital to those of pediatric patients at general hospitals in the St. Louis area.

CT has long been the primary tool for determining whether someone complaining of possible appendicitis symptoms actually has the condition and needs surgery. Concerns over radiation exposure to children have led doctors at St. Louis Children’s to move toward ultrasound instead, according to the study.

About 85 percent of children initially evaluated at a general hospital received preoperative CT scans, but only 45 percent of those initially seen at Children’s were scanned by CT. More than half of the Children’s patients received ultrasound, compared with 20 percent at general hospitals.

“Appendicitis is a very tough diagnosis because its symptoms overlap with viral infections and other problems,” said Jacqueline M. Sato, lead author of the study. “We don’t want to operate when the appendix is fine, but if we wait too long, an inflamed appendix can rupture or perforate, making recovery more complicated and much slower.”

Dr. Saito is assistant professor of surgery in the pediatric surgery division at Washington University School of Medicine. She was quoted in a university news release. The study was published online December 24 in Pediatrics.

The study found that both CT and ultrasound were less accurate in diagnosing appendicitis when performed at a general hospital rather than at Children’s. Dr. Saito cautioned:

Ultrasound scans are difficult to perform correctly in this context, and what specialists can do at Children’s Hospital may not be realistic or even available in a general hospital, which doesn’t care for children as often.

The study also concluded that, despite widespread imaging, too many children undergo unnecessary appendectomies. Its authors suggested that new strategies to improve diagnostic accuracy for childhood appendicitis were “urgently needed.”

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Related seminar: Pediatric Radiology—Clinical and Radiology Perspectives

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