Diagnostic Accuracy of Pediatric Abdominal Ultrasound: Do You Need a Full Bladder?

Summary and Comment |
November 21, 2016

Diagnostic Accuracy of Pediatric Abdominal Ultrasound: Do You Need a Full Bladder?

  1. Daniel M. Lindberg, MD

This study suggests the answer is no.

  1. Daniel M. Lindberg, MD

Ultrasound has replaced computed tomography (CT) as the initial imaging study for most children with suspected appendicitis. Some institutions require bladder filling to facilitate ultrasound examinations, but this can be uncomfortable and delay care. These authors evaluated the diagnostic accuracy of transabdominal ultrasound with and without filled bladders in a retrospective cohort of 678 children with suspected appendicitis at a single center.

Ultrasound images were reviewed to determine the percent of expected bladder capacity; bladders filled to <75% capacity were considered suboptimally filled. Ultrasound reports were considered to be “diagnostic” if they demonstrated a fully visualized normal appendix, appendicitis, or an alternative diagnosis for the patient's symptoms. Investigators also determined whether ovaries were fully visualized in girls.

Among 678 children aged 2 to 17 years, 283 had full bladders and 395 had suboptimally filled bladders. Ultrasound exams were diagnostic in 47% of children with full bladders and 52% of those with suboptimally filled bladders (difference not significant). This finding held in both sexes. Ovaries were visualized significantly more often in girls with full bladders (96%) than in those with suboptimally filled bladders (81%).

Comment

Routinely making patients wait for urine to accumulate or endure catheterization is not patient-centered and appears unwarranted based on the high rate of diagnostic studies obtained in patients with unfilled bladders. In order to decrease risk of perforation and to improve throughput and comfort, ultrasound should be attempted early in children with suspected appendicitis. Nondiagnostic studies in children with unfilled bladders can be repeated.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel M. Lindberg, MD at time of publication Royalties UpToDate Grant / Research support Colorado Clinical and Translational Sciences Institute; Colorado Traumatic Brain Injury Trust Fund; Eunice Kennedy Shriver National Institute of Child Health and Human Development Editorial boards The Quarterly Update: Reviews of Current Child Abuse Medical Research; Child Abuse & Neglect: The International Journal Leadership positions in professional societies The Helfer Society (Executive Board Member at Large)

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