The greatest benefit of clinical scoring systems has been to differentiate low-risk patients who do not need surgery and generally do not require imaging from high-risk patients who can be triaged to surgical management, potentially without imaging [16-18]. Imaging should still be considered in cases where clinical judgement is at odds with the high or low risk stratification based on a scoring system. The major role for imaging in the context of clinical scoring systems is in the further evaluation of patients considered to have an intermediate risk of appendicitis [11]. While the specific cut-off values for intermediate risk vary based on the clinical score being used and the desired sensitivity and specificity, the intermediate-risk population is the subgroup that has historical, physical examination, or laboratory findings that do not qualify for either the low- or high-risk groups [13]. US Appendix ultrasound (US) is performed in all potential locations of the appendix with gradual increasing pressure to displace overlying bowel gas and content, which is known as the graded compression technique. Graded compression also serves to bring the appendix closer to the transducer. Appendiceal US can be performed as either a focused examination of the RLQ or as a complete abdominal US. For the purpose of this topic, US abdomen includes dedicated appendiceal study. Accuracy of appendix US varies widely, is operator dependent [19], and may be dependent on patient-specific factors, including obesity [20,21]. The sensitivity and specificity of US for the diagnosis of pediatric acute appendicitis and percentage of equivocal cases varies. US accuracy is optimized in experienced hands and can approach that of CT [22-25]. For this document, it is assumed all procedures are performed and interpreted by an expert.
Suspected Appendicitis Child. The greatest benefit of clinical scoring systems has been to differentiate low-risk patients who do not need surgery and generally do not require imaging from high-risk patients who can be triaged to surgical management, potentially without imaging [16-18]. Imaging should still be considered in cases where clinical judgement is at odds with the high or low risk stratification based on a scoring system. The major role for imaging in the context of clinical scoring systems is in the further evaluation of patients considered to have an intermediate risk of appendicitis [11]. While the specific cut-off values for intermediate risk vary based on the clinical score being used and the desired sensitivity and specificity, the intermediate-risk population is the subgroup that has historical, physical examination, or laboratory findings that do not qualify for either the low- or high-risk groups [13]. US Appendix ultrasound (US) is performed in all potential locations of the appendix with gradual increasing pressure to displace overlying bowel gas and content, which is known as the graded compression technique. Graded compression also serves to bring the appendix closer to the transducer. Appendiceal US can be performed as either a focused examination of the RLQ or as a complete abdominal US. For the purpose of this topic, US abdomen includes dedicated appendiceal study. Accuracy of appendix US varies widely, is operator dependent [19], and may be dependent on patient-specific factors, including obesity [20,21]. The sensitivity and specificity of US for the diagnosis of pediatric acute appendicitis and percentage of equivocal cases varies. US accuracy is optimized in experienced hands and can approach that of CT [22-25]. For this document, it is assumed all procedures are performed and interpreted by an expert.