Introduction The inherent variability of the history and exam inpaediatrics make acute abdominal pain a diagnostic challenge. Investigations such as white-cell-count (WCC), C-reactive-protein and radiological studies have been advocated tohelp objectify management. Whilst Computed Tomography is accurate, the amount ofradiation involved renders it unacceptable and thus many view ultrasonographyas an acceptable alternative. But do these tests add value?

Methods Retrospective review between 2002–2012. Data was collected for children under sixteen with acute abdominal pain undergoinginvestigation with ultrasound and haematological testing. For 2005,a retrospective review was conducted for children presenting with abdominalpain to obtain data on demographics, history and examination findings. Analysis for diagnostic accuracy was undertaken.

Results 5000 records were reviewed, and 1744 records included. 6% of children developed appendicitis. Findingsof worsening pain, associated with nausea or vomiting yielded moderatesensitivities and specificities (combined values over 70%). Fever was non-specific. Localised tenderness is the most sensitiveexam finding and rebound tenderness is the most specific, both having values over 90%. WCC and CRP offer similar sensitivitiesand specificities, both producing results under 80%. Only 30% of ultrasounds visualisedthe appendix, significantly dampening the sensitivity below 75%. The incidence of appendicitis in thenon-visualised group was 8%.

Conclusion No test is useful for ruling out appendicitis. Given thatthe incidence of appendicitis is higher in the non-visualised group, this isespecially so with ultrasonography. Clinical examination with senior input isthe most sensible strategy for managing children with acute abdominal pain.