Radiation-Free Diagnosis of Pediatric Appendicitis: Accuracy of Point-of-Care Ultrasonography and Magnetic Resonance Imaging

Abstract

Introduction: Appendicitis is a common pediatric surgical emergency, and it can often be difficult to diagnose. Computed tomography is commonly used as a diagnostic criterion standard, but herein, we describe the accuracy of a "radiation-free" diagnostic algorithm using point-of-care ultrasonography (POCUS) and magnetic resonance imaging (MRI) to diagnose pediatric appendicitis.

Methods: This was a retrospective chart review of all patients who had a POCUS ordered for evaluation of pediatric appendicitis. Results of POCUS and MRI were classified as positive, negative, or equivocal using previously described cutoffs and criterion standard of surgery/pathology or clinical follow-up. Diagnostic accuracy was calculated using traditional methods.

Results: We identified 209 patients for inclusion. The sensitivity and specificity of POCUS were 100% and 95.2%, respectively, in addition to 86 equivocal examinations, 6 of which had appendicitis. The sensitivity and specificity of MRI were 94.4% and 96.5%, respectively, in addition to 27 equivocal examinations, 2 of which had appendicitis.

Conclusions: Using POCUS and MRI for the diagnosis of pediatric appendicitis is a highly accurate way to avoid ionizing radiation in children. In our study, POCUS is as accurate as MRI, although this is limited by being mostly done by a single provider and a high number of equivocal examinations.