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Diagnosis of appendicitis in the paediatric emergency department

an update

Lawton, Bena , b , c; Goldstein, Henryc , d; Davis, Tessae , f; Tagg, Andrewg , h

Current Opinion in Pediatrics: June 2019 - Volume 31 - Issue 3 - p 312–316
doi: 10.1097/MOP.0000000000000749
EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue
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Purpose of review Concern regarding appendicitis is a common reason for presentation to the paediatric emergency department. We review recent progress in the use of biomarkers, imaging and clinical scoring systems in improving diagnostic accuracy in suspected appendicitis in children.

Recent findings Use of ultrasound, often performed at the bedside, is becoming more widespread with a parallel reduction in computed tomography (CT) use. Protocols for image acquisition and interpretation have been shown to improve diagnostic accuracy. Novel biomarkers have been explored and clinical diagnostic algorithms refined but none have achieved the level of diagnostic accuracy required.

Summary Appendicitis remains a clinical diagnosis. Point of care ultrasound is increasingly available and offers higher diagnostic accuracy than several routinely performed laboratory investigations. Recent publications provide support for increased use of clinician performed ultrasound, increased use of MRI, less use of CT, less emphasis on basic laboratory investigation and a renewed respect for the value of serial examination, particularly early in the course of illness.

aEmergency Department, Queensland Children's Hospital, Brisbane

bEmergency Department, Logan Hospital, Meadowbrook

cSchool of Medicine, University of Queensland, St Lucia

dDepartment of Paediatrics, Queensland Children's Hospital, Brisbane, Queensland, Australia

eEmergency Department, Royal London Hospital

fSchool of Medicine, Queen Mary University of London, London, UK

gEmergency Department, Sunshine Hospital

hSchool of Medicine, University of Melbourne, Melbourne, Victoria, Australia

Correspondence to Ben Lawton, Emergency Department, Queensland Children's Hospital, Raymond Terrace, South Brisbane 4101, QLD, Australia. Tel: +61 466301158; e-mail: ben.lawton@yahoo.com

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