Application value of abdominal ultrasonography in the diagnosis of pediatric patients aged 3-12 years with acute appendicitis

doi:10.4240/wjgs.v17.i9.105779

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Sep 27, 2025; 17(9): 105779
Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.105779

Application value of abdominal ultrasonography in the diagnosis of pediatric patients aged 3-12 years with acute appendicitis

Min Dai, Fu-Wang Zhang, Wei Jiang

Min Dai, Fu-Wang Zhang, Department of Ultrasound, The First People's Hospital of Jiashan County, Jiaxing 314100, Zhejiang Province, China

Wei Jiang, Department of Radiology, The First People's Hospital of Jiashan County, Jiaxing 314100, Zhejiang Province, China

Author contributions: Dai M wrote and reviewed the manuscript; Dai M, Zhang FW and Jiang W collected the data; all authors annotated the manuscript.

Institutional review board statement: This study was approved by the Ethic Committee of First People's Hospital of Jiashan County.

Informed consent statement: Data was de-identified and retrospectively collected, and therefore informed consent was not required from each patient.

Conflict-of-interest statement: The authors declare no conflicts of interest.

Data sharing statement: Data used in this study are available from the corresponding author.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Min Dai, Assistant Professor, Department of Ultrasound, The First People's Hospital of Jiashan County, No. 1218 Tiyu South Road, Jiaxing 314100, Zhejiang Province, China. jiashandaimin@163.com

Received: May 16, 2025
Revised: June 26, 2025
Accepted: July 24, 2025
Published online: September 27, 2025
Processing time: 131 Days and 0.1 Hours

Abstract

BACKGROUND

Early detection of acute appendicitis (AA) in pediatric cases, critical to avoiding life-threatening complications such as perforation or abscess, remains challenging.

AIM

To evaluate the utility of abdominal ultrasonography (AUS) in diagnosing pediatric AA.

METHODS

Overall, 102 pediatric patients (aged 3-12 years) suspected of having AA were enrolled and divided into the AA (n = 78) and non-AA (n = 24) groups. All children underwent AUS and computed tomography (CT). Comparative analyses regarding general patient characteristics and appendix-specific parameters were conducted. The diagnostic performance of AUS and CT in pediatric AA was evaluated.

RESULTS

All appendix-related parameters were greater in the AA group than in the non-AA group. The areas under the receiver-operating characteristic curves for pediatric AA diagnosis using AUS, CT, and AUS + CT were 0.870, 0.824, and 0.931 (all P < 0.001), respectively (AUS: 94.87% sensitivity, 79.17% specificity; CT: 89.74% sensitivity, 75.00% specificity; combined: 98.72% sensitivity, 87.50% specificity). The positive predictive value (PPV), negative predictive value (NPV), accuracy rate, positive detection rate, and misdiagnosis rate of AUS were 93.67%, 82.61%, 91.18%, 72.55%, and 20.83%, respectively. CT had a slightly lower PPV (92.11%) and NPV (69.23%), along with accuracy, positive detection, and misdiagnosis rates of 86.27%, 68.63%, and 25%, respectively. Their combination improved performance, yielding 96.25% PPV, 95.45% NPV, 96.08% accuracy, 75.49% positive detection rate, and 12.50% misdiagnosis rate.

CONCLUSION

AUS demonstrates certain diagnostic potential in AA diagnosis in pediatric patients, and its combination with CT further improves diagnostic efficacy.

Keywords: Abdominal ultrasonography; Pediatric acute appendicitis; Diagnosis; Clinical application value

Core Tip: Comparative research regarding the diagnostic effectiveness of abdominal ultrasonography (AUS) vs computed tomography (CT) for pediatric acute appendicitis (AA) remains limited. This study involved 102 children aged 3-12 years suspected of AA to compare their clinical utility based on appendiceal characteristics and diagnostic performance. The results confirmed notable abnormalities in appendix-related parameters among patients with AA. AUS showed diagnostic potential for pediatric cases, and the accuracy increased when it was combined with CT. These findings highlight a pathway (AUS + CT) to more accurate diagnoses, reduced surgical overtreatment, and efficient resource use.