Peds Radiology Super Powers for Equivocal Outside CT for Appendicitis

Written by Aaron Lacy

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When pediatric radiologists reinterpreted CT scans thought to be equivocal for appendicitis by community radiologists, they were able to provide a definitive diagnosis 88% of the time. Also, ultrasound for appendicitis at this children’s hospital was very accurate in equivocal cases.

Why does this matter?
A non-diagnostic or equivocal ultrasound does not mean absence of appendicitis; neither does an equivocal CT. If you lack pediatric radiology coverage and a CT scan is equivocal, you need to know what to do next. 

When correlating clinically just isn’t enough…
184 children transferred to a pediatric center with both CT for appendicitis at the referring community hospital and ultrasound upon arrival at the children’s hospital were included in this study. The goal was to evaluate the utility of reinterpretation of the outside CT scans by pediatric radiologists and the value of RLQ US in diagnosing acute appendicitis. 

Almost 60% of the patients (110/184, 59.8%) had outside radiology interpretations that were either equivocal or non-diagnostic. Reinterpretation of the same scans by pediatric radiologists identified 21 positive cases (19.1%), 78 negative cases (69.1%), and remained equivocal in 13 (11.8%). 110 patients with equivocal CT results underwent RLQ US at the receiving children’s hospital (101 were interpretable), with 27 identified cases of appendicitis (24.5%), 74 negative studies (67.3%), and 9 equivocal studies (8.2%).

These results suggest that equivocal pediatric CT scans for appendicitis should be reviewed by a pediatric radiologist. This would be a great use of teleradiology. It also suggests that RLQ ultrasound at a children’s hospital is a safe and viable first option for diagnosing appendicitis.

Editor’s note: This also suggests that community radiologists lack confidence when interpreting pediatric abdominal CT. Be wary of equivocal studies or “negative” studies in children with a tender abdomen. ~ Clay Smith

Source
Utility of Computed Tomography Overreading and Abdominal Ultrasound in Children With Suspected Appendicitis and Nondiagnostic Computed Tomography at Community Hospitals. Pediatr Emerg Care. 2020 Oct 29. doi: 10.1097/PEC.0000000000002283. Online ahead of print.

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