619 - Pediatric Emergency Medicine Physician Point-of-Care Ultrasound vs Radiology Ultrasound for Recognition of Perforated Appendicitis
Thursday, May 14, 2020
8:24 AM – 8:30 AM
Location: Majestic Ballroom: Majestic
Participants should be aware of the following financial/non-financial relationships:
Cloty Toro: No financial relationships or conflicts of interest
David Guernsey: No disclosure data submitted.
Naga Sushma Chavvakula: No disclosure data submitted.
John Agliano: No disclosure data submitted.
Antonios Likourezos, MA, MPH: No disclosure data submitted.
Mahlaqa Butt: No financial relationships or conflicts of interest
Alexander Arroyo, MD: No financial relationships or conflicts of interest
Jefferson Drapkin, MPH: No disclosure data submitted.
Background and Objectives: Abdominal ultrasound (US) is frequently performed to diagnose appendicitis in children presenting to the emergency department (ED) with acute abdominal pain. Early accurate diagnosis of perforated or non-perforated appendicitis will determine the need for immediate surgical intervention versus medical management. The aim of this study was to compare pediatric emergency physician Point-Of-Care Ultrasound (POCUS) to radiology performed ultrasound (RUS) in the recognition of perforated appendicitis in children.
Methods: We performed a retrospective chart review of patients age 2 to 18 years diagnosed in the pediatric emergency department (PED) with perforated appendicitis from January 2010 to December 2018. All patient data were obtained via the electronic medical record (EMR). An in-depth chart review was performed, and all data collection points were transcribed into a spreadsheet by the investigators. We included all patients with a POCUS and/or RUS done. We excluded patients who did not have any US as part of their appendicitis work-up. The CT scan or surgical/.pathology reports were used as the reference standard for determining if the appendix was truly perforated. The sensitivity and specificity of both POCUS and RUS findings were determined, and groups were compared.
Results: A total of 321 patients with the diagnosis of perforated appendicitis in the PED met the study criteria (72 had a POCUS performed, 249 had a RUS performed, and 36 patients had both performed). POCUS had a sensitivity of 17.9% (5 of 28), a specificity of 93.2% (41 of 44), a positive predictive value of 62.5% (5 of 8), and a negative predictive value of 64.1% (41 of 64). In the RUS group, sensitivity of 17.0% (17 of 100), a specificity of 98.7% (147 of 149), a positive predictive value of 89.5% (17 of 19), and a negative predictive value of 63.9% (147 of 230) was found.
Conclusion: Our abdominal POCUS sensitivity and specificity were in line with previously published studies of RUS performed to diagnose perforation from non-perforated appendicitis and also in line with in house RUS. This study provides support for the ability of POCUS to recognize perforated appendicitis as compared to RUS.