Incidence and significance of inconclusive results in ultrasound for appendicitis in children and teenagers

Purpose: Frustratingly, sonography to assess for appendicitis in children often leads to an inconclusive report (eg, 'suspicious for appendicitis') or nonvisualization of the appendix. To aid in planning who to image and how to interpret the results, we investigated whether these 2 results were more frequent in teenagers than preteens and the prevalence of appendicitis associated with each result. Methods: We retrospectively reviewed sonographic and surgical findings in patients <18 years (n = 189) referred with clinical suspicion of appendicitis over a 12-month period. Children (≤12.0 years old; n = 86) and teens (>12.0 years old; n = 103) were compared. Results: Prevalence of appendicitis was 34% in each group, similar to other centres; 0% for those with negative ultrasound reports (0/35), 10% for nonvisualized appendix (8/84), 68% for inconclusive report (15/22), and 85% for positive ultrasound (41/48). Teens were significantly more likely to have an inconclusive ultrasound. Inconclusive reports were because of borderline findings (eg, appendix size near 6 mm; 9/22), body habitus, bowel gas, or unusual findings due in retrospect to perforation. The rate of nonvisualization of the appendix did not vary significantly with age (42% vs 47%). Conclusion: An inconclusive result of ultrasound for appendicitis was significantly more frequent in teens than in preteens and carried a high (68%) likelihood of appendicitis. Conversely, a nonvisualized appendix was equally frequent in teens and preteens, and had a low likelihood of appendicitis (only 10% positive). These findings encourage the use of ultrasound in preteens in particular and can assist interpretation of these common results. (author)