Incremental diagnostic value of ultrasound in children with suspected acute appendicitis
In brief
Ultrasound reports raised appendicitis model AUC from 0.77 to 0.91
In a prospective cohort of 135 children, adding an appendicitis-compatible ultrasound report to age, symptom score and C-reactive protein improved the model's ability to distinguish appendicitis from no appendicitis. The finding supports using the report alongside clinical assessment, not alone; the single-centre study did not test whether this approach improves care or reduces CT use.
- Journal
- Pediatric radiology (Q1)
- Published
- 19 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Husam Ibrahimoglu, Sarper Sahin
- PMID
- 42895558
- DOI
- 10.1007/s00247-026-06812-x
Why clinicians should know about it
- Picked for Pediatric Surgery (paper of the day, 21 October 2026): Prospective cohort assesses ultrasound incremental diagnostic value
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (paper of the day, 21 October 2026): Ultrasound adds diagnostic value in pediatric appendicitis
Abstract
BACKGROUND: In children with suspected acute appendicitis, ultrasound is widely used as first-line imaging, but the incremental diagnostic value of the initial ultrasound report beyond clinical and laboratory variables remains unclear. OBJECTIVE: To evaluate the diagnostic contribution of an appendicitis-compatible initial ultrasound report beyond age, Pediatric Appendicitis Score, and C-reactive protein (CRP), and to describe the role of post-ultrasound computed tomography (CT) within an ultrasound-first pathway. MATERIALS AND METHODS: This prospective single-centre cohort included children aged 3-17 years evaluated for suspected acute appendicitis between May 2025 and March 2026. The primary outcome was histopathologically confirmed appendicitis. Logistic regression compared a clinical model including age, Pediatric Appendicitis Score total, and log2-transformed CRP with an ultrasound-extended model additionally including an appendicitis-compatible initial ultrasound report. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), Brier score, likelihood-ratio testing, and DeLong comparison. RESULTS: Among 135 children in the ultrasound-first cohort, 81 had histopathologically confirmed appendicitis and 54 formed the comparison group. The clinical model showed moderate apparent discrimination (AUC 0.771; 95% confidence interval 0.689-0.852; Brier 0.188). In 132 children with classifiable ultrasound reports, addition of an appendicitis-compatible initial ultrasound report increased the AUC from 0.772 to 0.912 and reduced the Brier score from 0.187 to 0.113. Post-ultrasound CT was performed in 52/135 children (38.5%); 29 had appendicitis and 23 did not undergo appendectomy. CONCLUSION: A clear appendicitis-compatible initial ultrasound report provided substantial incremental diagnostic information when added to age, Pediatric Appendicitis Score, and CRP, supporting its role as an integrated component of the diagnostic assessment rather than a standalone test.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.