• Jeffrey M Burford, Melvin S Dassinger, and Samuel D Smith.
• Pediatric Surgery, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202-3591, USA.
• J. Pediatr. Surg. 2011 Jun 1;46(6):1115-20.

PurposeDiagnosing appendicitis may require adjunct studies such as computed tomography or ultrasound (US). Combining a clinical examination with surgeon-performed US (SPUS) may increase diagnostic accuracy and decrease radiation exposure and costs.MethodsA prospective study was conducted including children with a potential diagnosis of appendicitis. A surgery resident performed a clinical examination and US to make a diagnosis. Final diagnosis of appendicitis was confirmed by operative findings and pathology. Results were compared with radiology department US (RDUS) and a large randomized trial. Analysis was performed using Fisher exact test.ResultsFifty-four patients were evaluated and underwent SPUS. Twenty-nine patients (54%) had appendicitis. Overall accuracy was 89%, with accuracy increasing from 85% to 93% between the 2 halves of the study. Radiology department US was performed on 21 patients before surgical evaluation, yielding an accuracy of 81%. Surgeon-performed US on those 21 patients yielded an accuracy of 90%. No statistical differences were found between any groups (P > .05).ConclusionAccuracy of SPUS was similar to RDUS and that of a large prospective randomized trial performed by radiologists. Furthermore, when the same clinician performs the clinical examination and US, a high level of accuracy can be achieved. With this degree of accuracy, SPUS may be used as a primary diagnostic tool and computed tomography reserved for challenging cases, limiting costs, and radiation exposure.Copyright © 2011 Elsevier Inc. All rights reserved.

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