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Abdominal ultrasound in the diagnosis of childhood appendicitis

Three Part Question

In [a paediatric patient with clinical signs of appendicitis] how [useful is an ultrasound scan] at [confirming or refuting the diagnosis]?

Clinical Scenario

An 8 year old patient presents to the emergency department with a six hour history of right iliac fossa pain; examination is suggestive of acute appendicitis. You wonder whether an ultrasound scan would be helpful for diagnosis.

Search Strategy

Medline 1966-12/00 using the OVID interface.
{[(exp child OR OR exp pediatrics OR OR AND (exp appendicitis OR acute] AND (exp ultrasonography OR OR exp ultrasonics OR OR} LIMIT to human AND english.

Search Outcome

Altogether 173 papers found of which 170 were irrelevant or of insufficient quality for inclusion. The remaining 3 papers are shown below.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Hahn HB et al,
3859 children age 1-17 years with suspected acute appendicitis. Gold standard was operative findings or result of clinical observation and repeat ultrsouondDiagnostic cohortAppendicitisSensitivity 90%

Specificity 97%

LR +30

LR -0.1
Inhospital follow up only
Schulte B et al,
1285 children age 1-15 years with acute appendicitis Gold standard was operative findings or result of clinical follow upDiagnostic cohortAppendicitisSensitivity 92%


LR +42

LR -0.08
Follow up rate unclear Follow up time not specified
Sivit CJ et al,
386 patients age 1-21 years with suspected acute appendicitis. Analysed for under and over 10 year olds Gold standard was operative findings or result of clinical follow upDaignostic cohortAppendicitis <10 years oldSensitivity 71%

Specificity 96%

LR +5.1

LR -0.34
Unblinded Excludes an unknown number of "obvious" appendicitis cases
Appendicitis >10 years oldSensitivity 84%

Specificity 86%

LR +6

LR -0.18


These studies show that ultrasound has a high sensitivity and specificity for the diagnosis of appendicitis. While specificity is high enough to SpIn, sensitivity is too low to SnOut. Further work investigating the diagnostic utility in high, moderate and low risk groups is warranted.

Clinical Bottom Line

A positive ultrasound is highly specific and can be used to rule in appendicitis in children. Sensitivity of this test is too low to rule out the diagnosis.


  1. Hahn HB, Hoepner FU, Kalle T, et al. Sonography of acute appendicitis in children: 7 years experience. Paediatr Radiol 1998;28:147-51.
  2. Schulte B, Beyer D, Kaiser C, et al. Ultrasonography in suspected acute appendicitis in childhood-report of 1285 cases. Eur J Ultrasound 1998;8:177-82.
  3. Sivit CJ, Kimberly AE, Stallion A, et al. Imaging evaluation of suspected appendicitis in a paediatric population: effectiveness of sonography versus CT. Am J Radiol 2000;175:977-80.