Ultrasound on the Spot to Diagnose Appendicitis

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Appendicitis diagnosis using point of care ultrasounds for children was accurate and avoided radiation

February 11, 2014 / Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

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(dailyRx News) Appendicitis is a common and serious ailment that requires immediate surgery. A new study looked at using an ultrasound to make diagnosis faster and easier without radiation exposure.

This new study found that point-of-care ultrasounds may be used by trained technicians in the emergency department to speed up diagnosis of appendicitis and reduce unnecessary waits.

According to the study's authors, using ultrasounds instead of CT scans reduces the patient’s exposure to radiation, which can lower their risk for certain health problems later in life.

"Seek immediate medical attention if you show signs of appendicitis."

This study was led by James W. Tsung, MD, MPH, associate professor of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai in New York.

The investigators worked with 150 children who were under evaluation for suspected appendicitis in an urban emergency department between May 2011 and October 2012.

These researchers looked at the effectiveness of using point-of-care ultrasounds to diagnose appendicitis instead of a CT scan, which can increase the lifetime risk of cancer.

According to the authors of this study, abdominal X-rays and CT scans are currently used to diagnose appendicitis. A CT scan uses multiple X-ray images to provide a more detailed view than a single X-ray can provide. Point-of-care ultrasounds use high-frequency sound waves to create a detailed image of the targeted body part.

This study showed that with focused ultrasound training, emergency technicians were able to correctly evaluate the results with 94 percent accuracy, a rate similar to radiologists.

This research team found that of the 150 children suspected to have appendicitis, 50 were in fact diagnosed with appendicitis and underwent surgery while the remaining 100 were discharged.

The researchers followed up with the discharged patients and found that there were no missed cases of appendicitis.

The results of this study also showed that the length of stay in the emergency room fell by two hours and 14 minutes, or 46 percent, for children who would have received a radiology department ultrasound.

Children who would have received a CT scan saw an average reduction of a full 6 hours, or 68 percent, compared to children waiting to receive a CT scan.

“From an institutional perspective, this is the most common surgical problem that we encounter with children in the emergency department,” Dr. Tsung said in a press statement. “CT scans have been the best imaging test for diagnosing appendicitis, but they expose children to radiation, which cumulatively can prove harmful, as increasing numbers of studies have shown.”

The authors of this study noted that several other studies have reported lifetime risks of cancer from abdominal and pelvic CT scans in children. The risk is estimated to be one fatal cancer for every 500 to 3,000 CT scans ordered, depending on age and sex.

The researchers said that efforts to reduce the 4 million radiation-emitting CT scans of children every year are underway, led by front-line physicians, radiologists and radiological professional societies. “CT scanning rate was reduced by over 35 percent, from a 44 percent CT scan rate prior to the study to a 27 percent rate during the study,” said study co-author Ee Tay, MD, assistant professor of emergency medicine and pediatrics at the Icahn School of Medicine.

dailyRx Contributing Expert Chris Galloway, MD, said, "This article adds to the growing body of evidence that ultrasound's sensitivity for appendicitis diagnosis approaches that of a CT scan when the ultrasound is available and in expert hands. Physicians know that we must minimize radiation from X-rays and CT scans in all patients, but especially pediatric patients as the cumulative effect of ionizing radiation spans a lifetime. The difficulty is that CT scans are readily available, rapid, sensitive, with the downsides being cost and radiation exposure."  

Dr. Galloway continued, "CT scans don't miss much and physicians are held to that standard as well so this is often a diagnostic dilemma. As ultrasound is more and more available, and used more and more, our sensitivity also increases and confidence in the findings. It must be mentioned that this was a small study of only 150 patients at a specialized academic center with extra oversight so the findings can not be extrapolated to most community emergency departments."

This study was limited by the single emergency department it collected data in and may not accurately represent the entire population.

This study was published February 10 in Academic Emergency Medicine.

The authors made no disclosures.