Previous pearls have focused on diagnosing appendicitis in children including the use of the pediatric appendicitis score and the Alvarado score. Many facilities have begun using focused ultrasound as the initial step in diagnosing appendicitis whilean aging to avoid radiation. The question remains what to do with an indeterminate ultrasound (when the appendix can not be visualized)? The retrospective study cited looked at combining a low Alvarado score (less the 5) with an indeterminate ultrasound and showed a negative predictive value of 99.6%. A total of 522 children were included in this study. 390 of these children had inconclusive ultrasounds. Only 1 patient with a low Alvarado score and inconclusive ultrasound has appendicits. Only children who had surgery or clinical follow up were included.
References
Blitman et al. Value of focused appendicitis ultrasound and alverado score in predicting appendicitis in children : Can we reduce the use of CT? AJR 2015; 204: W707-W712.
