Audit of patients for right iliac fossa pain with clinical concern for appendicitis referred for ultrasound

T. J. Wilson, Hull Royal Infirmary

To determine whether ultrasound findings correlated with surgical findings comparing to contemporary research findings.

Abdominal pain is a common complaint in children with multiple pathologies, ranging from malrotation to Meckel’s diverticulum. Appendicitis is a common surgical complaint, with 8% of all people having lifetime risk, and one peak occurs between the ages 10 and 30 years. Accurate diagnosis can be challenging; first-line investigation in children other than blood tests includes ultrasound. Many research studies show varying sensitivity and specificity; however, many of these research studies include adult patients.

This was a retrospective audit carried out between 1st January 2020 and 31st December 2021. The sample comprised 132 patients aged between 0 and 16 years. These children all had an ultrasound scan and were then followed up by a surgical review which consisted of clinical correlation to determine to proceed to surgery. 

Of the 132 children, 29 children had surgical findings of appendicitis. 21 of these patients also were reported as having ultrasound findings of appendicitis (true positive). 8 patients had a negative ultrasound, i.e. not having imaging appearances suggesting appendicitis, but were found to have surgical findings of appendicitis 
(false negative). There was one false positive and 102 true negatives. Sensitivity 95% and specificity of 93%.

This audit has shown that there is a high specificity (93%) for diagnosis of appendicitis on ultrasound and a sensitivity of 95%. This range corresponds to studies ranging from specificity of 85–98% and sensitivity between 55–96%. Over a 12-month period, 29 children were found to have appendicitis.

View poster