Choosing Wisely:

Don’t do CT for evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.

Rationale and Comments: Although CT is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is nearly as good in experienced hands. Since ultrasound will reduce radiation exposure, ultrasound is the preferred initial consideration for imaging examination in children. If the results of the ultrasound exam are equivocal, it may be followed by CT. This approach is cost-effective, reduces potential radiation risks, and has excellent accuracy, with reported sensitivity and specificity of 94%.
Sponsoring Organizations:
  • American College of Radiology
  • Sources:
  • American College of Radiology Appropriateness Criteria
  • Disciplines:
  • Emergency medicine
  • Pediatric
  • Surgical
  • References: • Wan MJ, et al. Acute appendicitis in young children: cost-effectiveness of US versus CT in diagnosis-a Markov decision analytic model. Radiology. 2009;250:378-86.
    • Doria AS, et al. US or CT for diagnosis of appendicitis in children? A meta-analysis. Radiology. 2006;241:83-94.
    • Garcia K, et al. Suspected appendicitis in children: diagnostic importance of normal abdominopelvic CT findings with nonvisualized appendix. Radiology. 2009;250:531-7.
    • Krishnamoorthi R, et al. Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology. 2011;259:231-9.
    • American College of Radiology. ACR Appropriateness Criteria: right lower quadrant pain/suspected appendicitis.
    • Frush DP, et al. Imaging of acute appendicitis in children: EU versus U.S. or US versus CT? A North American perspective. Pediatr Radiolo. 2009;39(5):500-5.

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