Emergency Physicians’ Point of Care Ultrasonography (POCUS) Competency Assessment for the Diagnosis of Acute Appendicitis in Pediatric Cases

Abstract

Aim:To evaluate the accuracy of emergency physicians performed point-of-care ultrasonography (EP-POCUS) in diagnosing acute appendicitis (AA) in the pediatric age group who had abdominal pain and compare sonographic findings with those of radiologists.Materials and Methods:One hundred twenty-three children who had abdominal pain were included in the study. EP-POCUS and radiology department ultrasonography (RADUS) performed on each case. Sonographic findings [non-compressible bowel loops, target sign, edema in the surrounding tissue, appendix diameter, peri-appendiceal abscess, appendicitis positivity (a non-compressible and non-peristaltic blind ending tubular structure >6 mm) and presence of mesenteric lymphadenitis] of the EP-POCUS and RADUS were recorded seperately and compared to evaluate accuracy of the EP-POCUS and RADUS. Definitive diagnoses were determined by pathological evaluation of appendectomy specimens.Results:Thirty-six (29.2%) patients were diagnosed AA and hospitalized by the surgeon, 30 (24.3%) of which were confirmed pathologically. According to pathological diagnose, the EP-POCUS’s sensitivity was 73.3%, specificity was 89.2%, the RADUS’s sensitivity was 76.7%, the specificity was 96.8% and significantly consistent with in diagnosing AA (Kappa coefficient: 0.64, p<0.005). EP-POCUS accuracy in AA diagnosis did not differ between age groups.Conclusion:EP-POCUS on pediatric patients acts as an auxiliary and useful approach in AA diagnosis. Training and experience may increase the accuracy rates.

Keywords

• acute appendicitis
• bedside ultrasonography
• pediatrics
• point-of-care ultrasonography