Current approaches to diagnosing acute appendicitis: pitfalls and progress.

Abstract

Purpose of review: Pediatric appendicitis remains a common diagnostic challenge faced in the emergency department. In this review, we provide an update on recent literature regarding the diagnosis of pediatric appendicitis via labs, imaging, and clinical prediction scores, and provide a summary of key pitfalls in diagnosing this condition.

Recent findings: Progress has been made in laboratory evaluation for the diagnosis of pediatric appendicitis with newer markers being under investigation, though standard markers such as white blood cell count and C-reactive protein remain prominent. From an imaging standpoint, there is emphasis on the use of ultrasound as the primary imaging modality, and creating new protocols for magnetic resonance imaging as a secondary imaging method if ultrasound is inconclusive. Clinical prediction scores continue to be a promising diagnostic tool with the literature indicating high specificity but rather low sensitivity. A wide array of diagnostic practices exist creating disparities in care, particularly with imaging.

Summary: Pediatric appendicitis is a challenging diagnosis with ongoing research efforts focused on novel laboratory markers that are more sensitive and specific, prioritizing the use of nonionizing radiation imaging modalities, and improving reliability of clinical prediction scoring tools. Reducing disparities in care surrounding pediatric appendicitis should be a focus for future research.