Does size matter? Correlation of ultrasound findings in children without clinical evidence of acute appendicitis.

PURPOSE: The purpose of this study was to determine whether children with a positive ultrasound (US) for acute appendicitis but a negative clinical picture developed appendicitis requiring definitive management.

METHODS

After obtaining IRB approval, we conducted a retrospective review of patients ≤17years who presented with possible acute appendicitis between April 1st, 2014, and December 31st, 2015. We included patients with a US suggestive of acute appendicitis based on size criteria but without concerning clinical features. Patients were discharged from the emergency department (ED) or admitted for observation. Variables included demographic data, US characteristics, clinical findings, length of follow-up, and appendectomy.

RESULTS

Of the 31 patients identified, 45% were male and average age was 11.3yrs. On US, the average maximal diameter of the appendix was 6.93mm. The median length of follow-up was 16.8 months, including 10 returns to the ED by 9 patients. Three of these underwent immediate laparoscopic appendectomy, while one had interval appendectomy. There were no cases of perforated appendicitis, and only 2 cases demonstrated pathology consistent with appendicitis.

CONCLUSION

These findings demonstrate that it is safe to consider conservative measures such as observation or discharge in children with a positive US for appendicitis based on size criteria but a negative clinical picture.

LEVEL OF EVIDENCE: 4.