Background: Acute appendicitis is the most common surgical emergency in the paediatric age group. Ultrasonography (USG) is widely used as the first-line imaging modality due to its cost-effectiveness and absence of radiation. However, false-positive USG results lead to unnecessary surgeries and associated morbidity. Identifying risk factors for such false-positive findings is essential for improving diagnostic accuracy. Objectives: To identify the risk factors associated with false-positive ultrasound diagnosis in paediatric acute appendicitis at a tertiary care centre of West Bengal. Methods: This cross-sectional study was conducted on 68 paediatric patients (age ≤18 years) admitted with clinical suspicion of acute appendicitis and who underwent USG abdomen, followed by surgical intervention. Data on sociodemographic profile, clinical presentation, USG findings, and histopathological reports were collected. False-positive USG was defined as USG suggesting appendicitis with a normal histopathological report. Statistical analysis was performed using SPSS version 26.0.Results: Out of 68 cases, 14 (20.6%) were false-positive on USG. Female gender (p = 0.03), younger age group (6–10 years), obesity (BMI ≥95th percentile), and excessive bowel gas were identified as significant risk factors. Sensitivity and specificity of USG were 82.1% and 79.6%, respectively. Conclusion: False-positive USG in paediatric appendicitis is not uncommon. Female gender, younger age, obesity, and bowel gas interference are significant contributing factors. Adjunct CT or MRI should be considered in such high-risk patients to reduce unnecessary operative interventions.

False-positive ultrasound, paediatric appendicitis, acute appendicitis, diagnostic accuracy, cross-sectional study, West Bengal