Austin-Page LR, Pham PK, Elkhunovich M, et al. - Via reviewing 5 years of pediatric emergency department encounters including US evaluations for appendicitis, researchers investigated how diagnostic accuracy of ultrasound (US) for appendicitis has changed over time, following implementation of an US-first protocol. In addition, they evaluated trends in utilization and factors linked with accuracy of US. Among 1,058 encounters, 267 (25.2%) had a conclusive US report; overall accuracy rate was 24.5%. Over 5 years, there appeared a significant improvement in the diagnostic accuracy of US for appendicitis from 13.9% to 31.5%. Overall sensitivity of 80.7% and specificity of 77.6% were observed. Conclusive US was observed in significant correlation with male gender and dedicated US of the appendix. Higher body mass index was significantly linked with equivocal US. The findings are overall encouraging for implementation of US-first protocols in facilities using computed tomography-based diagnostic protocols to decrease childhood radiation exposure.