Ultrasound isn't cutting it for diagnosing pediatric appendicitis, new data show
Though many clinicians consider ultrasound the go-to imaging modality in instances of suspected pediatric appendicitis, new data suggest that it is nondiagnostic for a significant amount of these cases.
Ultrasound and CT are considered the standard of care for pediatric appendicitis, but each come with drawbacks; US is highly dependent on the operator, reducing sensitivity and specificity. The modality also often lacks reproducibility as well. CT, on the other hand, provides more consistent quality, but it comes with increased radiation exposure, which most providers look to avoid in children.
MRI, in many cases, is the most accurate modality. However, it also comes with the caveat of decreased efficiency and can lead to prolonged hospital stays. To address this, some organizations have begun to deploy rapid MRI protocols in an attempt to capture better visualization of the area of interest without disrupting clinical flow.
The authors of a new analysis published in Emergency Radiology recently compared the use of rapid MRI protocols against US, as both modalities spare children of ionizing radiation exposure, to determine whether either of the modalities’ benefits outweighed their drawbacks.
“Rapid MRI provides non-ionizing imaging with high sensitivity (96%–97%) and specificity (96%–97%),” Catherine M. Pivalizza, with the McGovern Medical School at The University of Texas Health Science Center, Houston, and colleagues noted. “The clinical setting can impact diagnostic accuracy and approach: community hospitals have previously been associated with 4.4-fold higher odds of obtaining pre-operative CT scans, rather than US and rapid MRI.”
The team retrospectively reviewed a large set of pediatric appendicitis cases from Children’s Memorial Hermann Hospital over a 6-month period. The hospital sees approximately 20,000 patients in its emergency department annually and has 24/7 access to US, rapid MRI and CT scans. The sensitivity and specificity of each modality were compared alongside patients’ length of stay at the hospital.
This revealed US alone to be inconclusive in more than 50% of cases. It yielded a sensitivity of 65.3%; in comparison, rapid MRI had a sensitivity of 97% and a specificity of 98.3%. US alone was associated with the shortest median length of stay, at 5.3 hours, with rapid MRI alone next in line, at 7.9 hours. US with subsequent rapid MRI was associated with the longest ED LOS, at 10.6 hours.
The group acknowledged that there is no perfect solution to the issue, but that a protocol that includes both modalities may be the happy medium for maintaining diagnostic accuracy for standard cases.
Read more about the team’s work here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.