Objective: --To determine the ability of ultrasonography to detect appendicitis and to identify other conditions responsible for symptoms in children with acute abdominal pain.
Design: --Cohort study. The accuracy of ultrasonographic results was assessed in relation to final diagnoses established by surgery or by composite clinical data and follow-up.
Setting: --Metropolitan, pediatric hospital; ambulatory and hospitalized patients.
Patients: --Consecutive sample of 178 pediatric patients who were referred for ultrasonography because of suspected acute appendicitis, but in whom the diagnosis could not be definitively established by clinical criteria.
Results: --Appendicitis was proven at surgery in 38 patients. Ultrasonography demonstrated the findings of appendicitis (noncompressible appendix with or without concomitant periappendiceal fluid collection or appendicolith) in 31 (82%) of these patients. Among the 140 children without appendicitis, other specific diagnoses were established by clinical, laboratory, and radiologic findings in 58 patients (including gynecologic diseases in 25, gastrointestinal tract abnormalities in 17, renal diseases in six, and extra-abdominal disease in 10). Ultrasonography aided in the diagnosis of other conditions in 34 (59%) of these 58 patients. No definitive clinical diagnosis was established in the remaining 82 patients. There were no false-positive results of ultrasonography.
Conclusion: --Approximately half of children referred for suspected appendicitis will have a final diagnosis of abdominal pain of unknown origin. In the remainder, ultrasonography is useful, both to establish the diagnosis of appendicitis and to aid in diagnosing other causes of acute abdominal pain.