Are You ‘Appy Now? POCUS for Appendicitis

October 27, 2021

Written by Megan Hilbert 

Spoon Feed
This study highlighted the operator dependence of POCUS for the evaluation of acute appendicitis in an undifferentiated emergency department population including both pediatric and adult patients.

Why does this matter?
Abdominal pain is a frequent emergency department chief complaint. Unfortunately, both physical examination and laboratory results are not reliable when considering the diagnosis of appendicitis. This study demonstrated moderate sensitivity (85%) and specificity (63%) of POCUS for identification of this pathology; meaning that we are far from being able to hang our hat on a diagnosis of appendicitis based on POCUS alone.

It’s not you, it’s me…. Or rather, it’s both of us
This article was a prospective, multicenter, observational study using a convenience sample of patients. RLQ ultrasounds were completed by mix of scanners including upper level EM residents, ultrasound fellows, and EM Attendings. There was a standardized checklist of required images and sonographic criteria that were to be met. Main analysis classified ultrasounds as “positive” or “negative” with indeterminate studies being included in the “positive” subgroup due to need for additional imaging or consultation. This evaluation resulted in the moderate sensitivity and specificity as detailed above. Sub group analyses were also completed and evaluated a variety of variables including patient age, BMI, and sonographer level of training. While there were small differences noted in sonographer level of training, the most robust findings suggest a slight increase in sensitivity (87%) and specificity (69%) in identification of acute appendicitis in pediatric patients and adults with BMI < 30 as compared to those with BMI > 30. These findings are consistent with prior studies and highlight the need for further advancement of POCUS – specifically in the RLQ.

Source
A prospective, multicenter evaluation of point-of-care ultrasound for appendicitis in the emergency department. Acad Emerg Med. 2021 Aug 22. doi: 10.1111/acem.14378. Online ahead of print.