Prospective Observational Study of Emergency Department Point-of-Care Ultrasound to Differentiate Between Complicated and Uncomplicated Appendicitis
Almaz S. Dessie and Maria Kwok are considered co-first authors.
We want to thank the research coordinators at Columbia University Irving Medical Center, Megan Nye and Marc Vindas, for their assistance in collecting data from the various sites, statisticians Yiling Yang and Shing M. Lee from the Department of Biostatistics at the Columbia University Mailman School of Public Health for their assistance in data analysis, and the P2Network for contributing sites to participate in this study.
Abstract
Objectives
Acute appendicitis is a common surgical emergency in children. Prior radiology studies have described Puylaert staging on ultrasound to determine the severity of appendicitis. We investigated the feasibility and utility of assessing Puylaert staging on emergency department (ED) point-of-care ultrasound (POCUS) to differentiate uncomplicated from complicated appendicitis in children.
Methods
This was a pilot feasibility study of children ages 5–17 diagnosed with acute appendicitis in nine pediatric EDs. POCUS was performed by trained ED physicians. Puylaert staging of the submucosal layer was used to categorize the severity of appendicitis (stages 1–4) and was compared with surgical pathology reports. Test characteristics were computed to evaluate the accuracy of POCUS in differentiating appendicitis severity. Physicians recorded time to complete POCUS, ease of use, and their perception of acceptability by patients and families.
Results
Of 72 patients with complete data, all patients with uncomplicated appendicitis were accurately identified using POCUS (Puylaert stage 1 or 2). The sensitivity for identifying complicated appendicitis (Puylaert Stage 3 or 4) was 100% (95% CI: 77%–100%), and specificity was 65% (95% CI: 52%–78%). Ninety four percent of physicians agreed that the POCUS was easy to perform. One hundred percent agreed that it was well accepted by families. The average time to complete POCUS was 8 min.
Conclusions
This study supports the feasibility and utility of assessing Puylaert staging by POCUS for children with appendicitis in the ED. High sensitivity to rule out complicated cases coupled with ease of use and perceived patient acceptance make this a potential adjunct to aid in the management of pediatric appendicitis.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
