457 - Ultrasound Findings in Acute Appendicitis and Body Mass Index in Children in Two Urban Community Hospitals

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 457
Publication Number: 457.312

Toshihide Kuroe, Flushing Hospital Medical Center, Flushing, NY, United States; Priya Mallikarjuna, Flushing Hospital Medical Center, New York, NY, United States; Lochana KC, Flushing hospital medical center, Flushing, NY, United States; Narihan Osman, Flushing Hospital Medical Center, Scotch plains, NJ, United States; Vivian Chang, Stony Brook Children's Hospital, Elmhurst, NY, United States; Won Baik-Han, Flushing Hospital Medical Center, Flushing, NY, United States; Lily Q. Lew, Flushing Hospital Medical Center, Flushing, NY, United States; Gagan Gulati, Flushing Hospital Medical Center, Flushing, NY, United States

Presenting Author(s)

Toshihide Kuroe, MD

Resident
Flushing Hospital Medical Center
Flushing, New York, United States

Background: Acute appendicitis (AA) is a common cause of acute abdominal pain in children and adolescents. Alvarado score (AS) is a ten-point clinical scoring system to identify AA. Ultrasound (US) is the initial imaging study to evaluate the appendix. Only after non-visualization of the appendix will some need further evaluation by CT. Body mass index (BMI) is a measure of body fat determined by height and weight. There are reports of an inverse relationship on the quality of US and BMI in adults. With increasing obesity in children and adolescents, there are no studies correlating findings in the US of appendix, AS and BMI.

Objective: To explore correlation of the US of appendix with AS and BMI.

Design/Methods: A retrospective review of patients aged 2 to 18 years visiting Pediatric EDs of Flushing Hospital Medical Center and Jamaica Hospital Medical Center from Jan 1, 2017 to Dec 31, 2021 with diagnosis of AA and having US of appendix. Data extracted from EHR included demographics (age, gender, ethnicity), clinical findings to determine AS, BMI, and imaging studies. AS of 1-6 is least likely to require surgery while a score of 7-10 is more likely to require surgery. Findings of the US of appendix were either visualized or non-visualized. BMI were categorized into underweight, normal, overweight and obese based on age and gender. Data were analyzed using SPSS and percentages, p< 0.05 was considered significant.

Results: Of 221 patients identified with AA and having US of appendix, 18 were excluded for missing height. Among the remaining 203, 62% were male, mean age 10.6+3.9 years, the predominant ethnicities were Hispanic (67%) followed by Asian (21%) and African-American (5%) and 28% had obese BMI. Less than half (46%) had non-visualized appendix on US. No significant differences were found in US visualization of appendix across all BMI groups (p=0.59) nor in percentages of visualized and non-visualized appendices between those with AS 1-6 and AS 7-10, p=0.77 were not significant. There were no overall differences between AS groups across BMI categories, p=0.60. Among patients with AS 1-6, 31% of the obese had non visualized appendix compared to 19% whose appendix were visualized. No significant differences were found within either AS 1-6 (p=0.60) or AS 7-10 (p=0.36) in relations between BMI and US. All patients with non-visualized appendix on US had abdominal CT or MRI if pregnant.

Conclusion(s):

In our small sample, non-visualization of appendix on US was not correlated with AS or BMI. Healthcare providers should continue to order US regardless of BMI.