Ultrasound Training Agreement on Pediatric Appendicitis and Normal Appendix Detection

Educational video datasets are a valuable tool for training emergency department (ED) clinicians in point-of-care ultrasound (PoCUS) applications. This study aimed to evaluate interobserver agreement on key sonographic findings of normal appendix and appendicitis in children using a curated PoCUS video dataset. Three sets of 25 ED PoCUS videos were selected: the first featured normal appendices or normal bowel in patients without appendicitis, the second was used for testing the visualization of the normal appendix, and the third focused on cases of appendicitis, including associated findings such as appendicolith and perforation. Four participant sonologists, categorized as experienced or novice, were trained and tested on these datasets. Cohen’s Kappa was calculated for various parameters: visualization of any part of the normal appendix (κ = 0.71), normal appendix from tip-to-cecum (κ = 0.43), appendicitis (κ = 0.53), appendicolith (κ = 0.63), and appendiceal perforation (κ = 0.46). Experienced sonologists demonstrated higher agreement compared to novices, particularly in identifying appendicitis (κ = 0.78 vs. 0.31) and normal appendix tip-to-cecum (κ = 0.50 vs. 0.36). These findings highlight the impact of experience on diagnostic precision and the utility of educational video datasets for skill acquisition in pediatric PoCUS. Effective visualization of the normal appendix and recognition of appendicitis-related findings can aid in rapid and accurate decision-making, minimizing the need for additional diagnostic imaging and facilitating appropriate management strategies. Future research should explore larger, multicenter studies to validate these findings and further enhance training methodologies in PoCUS.