Complementary Computed Tomography to Inconclusive Ultrasonography in Children with Suspected Acute Appendicitis: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis evaluated negative appendectomy rates in children with suspected acute appendicitis (AA) following an initial inconclusive or negative ultrasonography (US), comparing a US-only diagnostic pathway to one involving subsequent computed tomography (CT). Analyzing five studies with 1,250 pediatric patients, the review found that a US-only approach was associated with significantly lower odds of negative appendectomy than a pathway including CT, particularly in cases with an inconclusive initial US. Despite low statistical heterogeneity, the certainty of evidence was rated low to very low due to observational study designs, risk of bias, and imprecision. These findings support prioritizing clinical reassessment and repeat US to reduce unnecessary surgeries and radiation exposure, while emphasizing that clinical judgment and local resources remain essential in guiding imaging decisions.