Suspected Appendicitis in Children: Point of Care Ultrasound Evaluation

Jim Tsung, MD, MPH Department of Emergency Medicine Mount Sinai School of Medicine Guggenheim Pavilion 1 Gustave Levy Place Box 1149 New York, NY Interview with:
Jim Tsung, MD, MPH
Department of Emergency Medicine
Mount Sinai School of Medicine
Guggenheim Pavilion
New York, NY 10029 What are the main findings of the study?

Dr. Tsung:

1.  Point-of-care ultrasound performed by clinicians was as accurate as ultrasound performed in the radiology department for evaluating appendicitis in children.

2.  This led to significant reductions in emergency department stays when point-of-care ultrasound was able to contribute to the decision to send the patient to the operating room or to discharge home without further imaging studies. On average, a 2 hour (46%) reduction in ED LOS for patients only requiring radiology ultrasound and a 6 hour (68%) reduction in ED LOS for patients that needed CT scan.

3.  Point-of-care ultrasound can also reduce the rate of CT scans obtained when used as a front-line test, 44% to 27%. Were any of the findings unexpected?

Dr. Tsung:

1.  In 4 instances, patients received a disposition (go to operating room or discharge home) when point-of-care ultrasound results were conclusive and radiology ultrasound results were inconclusive.   Ordinarily patients with inconclusive radiology ultrasound results go onto receive CT scan in our hospital.  What should clinicians and patients take away from your report? 

When Point-of-care ultrasound are conclusive:

1.  Patient’s ED length of stay maybe reduced, especially important in overcrowded emergency departments and
2. Cancer-causing radiation from CT scans can be avoided, very important in children as they are much more sensitive to radiation than adults are. What recommendations do you have for future research as a result of this study?

Dr. Tsung:

1.  Future research on training and education methods to teach front-line clinicians including medical students, and residents how to use point-of-care ultrasound to diagnose appendicitis.

2. Future research on methods to improve the sensitivity of ultrasound to rule-out appendicitis; this will help decrease the CT scan rate even further.

The Effect of Point-of-care Ultrasonography on Emergency Department Length of Stay and Computed Tomography Utilization in Children With Suspected Appendicitis

Academic Emergency Medicine 2014; 21: 163170 © 2014 by the Society for Academic Emergency Medicine

  1. Presented at the Pediatric Academic Societies Annual Meeting, Washington, DC, May 2013; and the Society for Academic Emergency Medicine Annual Meeting, Atlanta, GA, May 2013


Last Updated on February 11, 2014 by Marie Benz MD FAAD