DIAGNOSTIC ACCURACY OF ABDOMINAL ULTRASONOGRAPHY FOR ACUTE APPENDICITIS IN CHILDREN PRESENTING TO TERTIARY CARE HOSPITALS IN PESHAWAR, PAKISTAN

Abstract

Background: Acute appendicitis is one of the most common causes of emergency abdominal surgery in children. Its diagnosis can be challenging because clinical symptoms overlap with gastrointestinal, urinary, and mesenteric conditions. Although computed tomography (CT) provides high diagnostic accuracy, its use in children is limited by exposure to ionizing radiation. Ultrasonography is a non-invasive, widely available, and radiation-free imaging modality that may serve as an appropriate first-line investigation in resource-constrained healthcare settings.

Objective: To determine the diagnostic accuracy of abdominal ultrasonography for detecting acute appendicitis in children presenting with suspected appendicitis to tertiary care hospitals in Peshawar, Pakistan.

Methods: A prospective cross-sectional study was conducted in the radiology and emergency departments of selected tertiary care hospitals in Peshawar. Children aged 5–16 years with clinical suspicion of acute appendicitis were enrolled through consecutive sampling. Abdominal ultrasonography was performed by experienced radiologists using the graded-compression technique. Sonographic findings included appendiceal diameter, compressibility, wall thickness, periappendiceal fluid, echogenic periappendiceal fat, appendicolith, and increased vascularity. Histopathological examination of the surgically removed appendix served as the primary reference standard; for patients managed conservatively, clinical follow-up served as the reference. Sensitivity, specificity, positive and negative predictive values, and overall diagnostic accuracy were calculated.

Results: A total of 230 children (121 girls, 109 boys; mean age 11.44 ± 2.90 years) were enrolled. Preoperative ultrasound identified acute appendicitis in 112 patients (48.7%), while the reference standard confirmed appendicitis in 150 patients (65.2%). The sensitivity and specificity of ultrasonography were 58.0% and 68.8%, respectively. Positive and negative predictive values were 77.7% and 46.6%, respectively, with an overall diagnostic accuracy of 61.7%. The area under the ROC curve was 0.63 (95% CI: 0.56–0.70), indicating fair-to-moderate diagnostic performance. The appendix was visualised in 73.0% of cases; common positive findings included a non-compressible appendix with a diameter >6 mm (42.6%) and wall thickening (33.0%).

Conclusion: Abdominal ultrasonography demonstrates moderate diagnostic accuracy for pediatric acute appendicitis in the Peshawar tertiary care setting. While ultrasound is a valuable radiation-free first-line imaging tool, its moderate sensitivity and specificity indicate that it should be used together with clinical scoring systems and laboratory markers to optimise diagnostic accuracy and reduce negative appendectomy rates.