Lab tests and ultrasounds identify children who need surgical treatment for appendicitis

Data from two standard diagnostic tests commonly obtained in children evaluated for abdominal pain - when combined - can improve the ability of emergency department physicians and pediatric surgeons to identify those patients who should be sent to the operating room for prompt removal of an inflamed appendix; those who may be admitted for observation; and those who may safely be discharged home, according to a new study published online as an "article in press" in the Journal of the American College of Surgeons (JACS). The study will appear in a print edition of the Journal this spring.

The researchers from Boston Children's Hospital retrospectively examined major categories of ultrasound findings in children with suspected appendicitis in conjunction with blood tests that signal bacterial infection in 845 children seen in the emergency department between 2010 and 2012. It is believed to be the one of the first studies to show that the addition of the white blood count (WBC) and polymorphonuclear leukocyte differential (PMN%) data can significantly improve the clinical value of ultrasound in diagnosing appendicitis in children, according to the study authors.

"Ninety percent of all hospitals perform laboratory studies and ultrasound when there is a reasonable suspicion of appendicitis in children. Hospitals tend to look at the results of these studies independently, however, and the improved diagnostic value of using these in a complimentary fashion has not yet been reported. The diagnostic evaluation approach in this study can be used by other institutions as a diagnostic tool to help emergency department physicians and surgeons provide better care by avoiding treatment delay in very high-risk patients and unnecessary admissions for very low risk patients," according to lead study author and pediatric surgeon Shawn J. Rangel, MD, MSCE, FACS, at Boston Children's Hospital.

Emergency physicians and surgeons typically order ultrasound scans to obtain images of the appendix and the surrounding tissues in children with acute abdominal pain to look for evidence of appendicitis. Sonographic scans often do not lead to a definitive conclusion about the presence or absence of appendicitis, however. In the Boston Children's Hospital study, a radiologist could not identify a normal appendix or any evidence of appendicitis on sonogram in more than half of all patients with suspected appendicitis. This relatively high rate of equivocal studies is not uncommon in children, however, and has been reported at other hospitals that also routinely evaluate children with abdominal pain.

A Rapid Blood Test to Quickly Rule Out Appendicitis?

A new rapid blood test to rule out appendicitis among the 8 million patients who come to U.S. emergency rooms with abdominal pain each year may save patients from unnecessary radiation from a diagnostic CT scan, eliminate extra tests and hours of hospital observation, and cut costs in the process. The test, which is currently being studied at two Penn Medicine hospitals and 11 other sites, screens for a novel biomarker of inflammation, and is designed to be used along with other common blood tests used to detect appendicitis. Young women and children are expected to benefit most from the test, since their reproductive organs are especially sensitive to radiation from imaging studies.