Purpose or Case Report: Background: Prior studies have shown significant discrepancy between the initial radiologist and pediatric radiologist interpretation of imaging exams performed on pediatric patients. Studies specifically focused on the rate of discrepancy of ultrasound (US) exams for suspected appendicitis and intussusception are deficient.
Objective: To determine the agreement and discrepancy rates, and the clinical impact of discrepancies in the diagnosis of appendicitis and ileocolic intussusception between initial US performed at referring community hospitals and second (2^nd) opinion US performed at an academic pediatric tertiary care hospital.
Methods & Materials: This was a retrospective study. The inclusion criteria were: 1) age≤18 yrs, 2) had an US performed at a referring hospital for suspected appendicitis or ileocolic intussusception, 3) availability of the initial US images and report or results of the report on our electronic medical record system or PACS, and 4) had a repeat US at our institution within 48 hours. The agreement and discrepancy between the results of the initial and the 2nd opinion US, and the agreement of the results with the final clinical diagnosis were evaluated.
Results: We included 234 patients with clinical suspicion of appendicitis (age range 1-16 years, mean age: 7.4 years) and 150 patients with suspicion of intussusception (age range 6 days-16 years, mean age: 3.6 years). We found only moderate agreement between the results of the initial US and those of the 2^nd opinion US, with a kappa of 0.23 (95% CI 0.13-0.33) for cases with suspicion of appendicitis and kappa of 0.35 (95% CI 0.23-0.47) for those with suspicion of intussusception. There were discrepancies between the results of the initial and 2^nd opinion US exams in 33.3%(78/234) of cases with suspicion of appendicitis, and in 31.3%(47/150) of cases with suspicion of intussusception. The results of the 2^nd opinion US exams had a higher agreement rate with the final clinical diagnosis (83.8% and 99.3% for cases with suspicion of appendicitis and intussusception, respectively) compared to the agreement of the initial US exams with the final clinical diagnosis (55.6 % and 67.3% for cases with suspicion of appendicitis and intussusception, respectively).
Conclusions: Obtaining a 2^nd opinion US by sonographers and radiologists with training in pediatric radiology is of value in pediatric cases with clinical suspicion of appendicitis and intussusception.