Ultrasound Should Be Strongly Considered as the Initial Imaging Modality in Acute Appendicitis in the Pediatric Patient

It is the position of the American Academy of Emergency Medicine that when appropriate expertise is available ultrasonography (US) should be strongly considered as the initial imaging modality when evaluating the pediatric patient with suspected acute appendicitis who requires imaging.


A growing body of research supports the use of ultrasonography as the initial imaging modality for pediatric patients with suspected acute appendicitis. The advent of widely available computed tomography (CT) shifted ED imaging for abdominal pain away from ultrasound and toward CT. CT of the abdomen and pelvis for pediatric appendicitis has a sensitivity of 94% and specificity of 95%. Though highly sensitive and specific its use in a child less than 1 year old will induce malignancy in approximately 1/550 scans. It is estimated for every 1000-2000 CT scans performed on children under 15 years old one malignancy will result. Approximately 5-9 million pediatric CT scans will be performed this year resulting in approximately 2,500-9,000 new cases of cancer during those individual’s lifetime. In the setting of suspected acute appendicitis, ultrasound has the benefit of reasonable accuracy without ionizing radiation. The lower sensitivity of ultrasound does not allow it to rule out appendicitis. However, incorporating ultrasonography into an algorithm of clinical impression, serial exams, and CT, when needed, is cost-effective.

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