502 - Ultrasound Visualization of the Appendix after IV Fluid Resuscitation in Acute Appendicitis in the Pediatric Emergency Department

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 502
Publication Number: 502.311

Ohmed Khilji, Medical College of Georgia at Augusta University, Augusta, GA, United States; Ohmed Khilji, Medical College of Georgia at Augusta University, Augusta, GA, United States; Deborah Huang, Medical College of Georgia at Augusta University, Augusta, GA, United States; Robert Gibson, Medical College of Georgia at Augusta University, North Augusta, SC, United States; Kristopher Lewis, Medical College of Georgia at Augusta University, Augusta, GA, United States; Andrew Pless, Medical College of Georgia at Augusta University, Augusta, GA, United States; Hongyan Xu, Medical College of Georgia at Augusta University, Augusta, GA, United States; Ann Marie Kuchinski, Augusta University, Augusta, GA, United States; Catherine Kwon, Geisinger Medical Center, Danville, PA, United States

Presenting Author(s)

Ohmed Khilji, MD (he/him/his)

Pediatric Emergency Medicine Fellow
Medical College of Georgia at Augusta University
Augusta, Georgia, United States

Background:

Acute appendicitis remains one of the most common surgical emergencies among children yet is sometimes missed during emergency department visits. This is likely because acute appendicitis can have varying presentations and because the appendix can be difficult to visualize in acute appendicitis because it is not always found in its typical anatomical location. Moreover, an empty bladder may make visualization of the appendix difficult. This is further exacerbated by the fact that most patients presenting with acute appendicitis have anorexia and vomiting as well as intravascular volume depletion. It is due to this that some clinicians propose giving a normal saline bolus prior to ultrasound guided visualization of the appendix. However this is not well studied.

Objective: Ultrasound is a fast, inexpensive, noninvasive imaging modality that has high sensitivity and specificity for diagnosing appendicitis in children. Ultrasound guided identification of the appendix in acute appendicitis is considered first line in most pediatric emergency departments because children are at increased risks of radiation induced complications associated with CT scans. In this study we examined if giving a normal saline bolus prior to ultrasound resulted in better visualization of the appendix.

Design/Methods: This study was a retrospective chart review of patients 3-18 years of age that presented to the pediatric emergency department at a Level I academic medical center between 01/01/2019 and 12/31/2021 with symptoms that resulted in an ultrasound appendix order. We examined the charts to see if these patients received an IV fluid bolus prior to being sent for ultrasound and compared the two groups to see if this resulted in an improved visualization of the appendix.

Results: In this study receiving an IV fluid bolus prior to being sent for an ultrasound did not result in a statistically significant improvement in visualization of the appendix. However, in males and in patients with lower BMI there was a statistically significant better chance of visualization of the appendix. This was also the case if the patient had appendicitis.

Conclusion(s): These results suggest that giving an IV fluid bolus prior to ultrasound of the appendix in patients with suspected appendicitis does not improve visualization.