Diagnostic accuracy of emergency physician performed graded compression ultrasound study in acute appendicitis: a prospective study

Abstract

Purpose Accurate early diagnosis of appendicitis can decrease its complications and minimize the mortality, morbidity and costs. This prospective study evaluates the accuracy of bedside emergency physician performed ultrasound study diagnosis in acute appendicitis. Methods Patients who were suspicious to have appendicitis based on their clinical findings were included and underwent emergency physician performed ultrasound study. Then they were followed up until the recognition of final diagnosis based on pathology report or identification of an alternative diagnosis. Ultrasound studies were done by post-graduate year three emergency medicine residents or emergency medicine attending physicians who were attended in a 4 h didactic and practical course and with 7.5 MHz linear probe both in longitudinal and axial axes. Results Ninety-seven patients were included and analyzed. 27 (27.8 %) of patients had appendicitis according to the results of emergency physicians performed ultrasound studies. 19 (70.37 %) of them had appendicitis according to their pathologic reports too. Forty-three (44.3 %) of patients had appendicitis according to pathology reports. Only 19 (44.18 %) of them were diagnosed by emergency physicians. Emergency physician performed ultrasound study had a sensitivity of 44.18 %, specificity of 85.18 %, positive predictive value of 70.37 %, negative predictive value of 65.71 % and overall accuracy of 67.01 % in diagnosing appendicitis in patients clinically suspicious to have acute appendicitis. Conclusion Emergency physician performed bedside ultrasound has an acceptable overall accuracy but its sensitivity is low thus it can help emergency physicians to diagnose the acute appendicitis when used in conjunction with other clinical and para-clinical evaluations but not per se.Keywords Accuracy Á Emergency physician performed ultrasound Á Appendicitis Á Diagnosis Riassunto Scopo Un'accurata diagnosi precoce di appendicite può diminuirne le complicanze e ridurre al minimo mortalità, morbilità e costi. Questo studio prospettico valuta l'accuratezza della diagnosi ecografica, eseguita in emergenza da un medico, nello studio di appendicite acuta. Metodi Sono stati inclusi I pazienti con sospetto clinico di appendicite e sottoposti ad ecografia d'emergenza eseguita da un medico. I pazienti sono stati poi seguiti fino alla diagnosi definitiva, basata su reperti di anatomia patologia o su una diagnosi alternativa. Le ecografie sono state eseguite da residents di medicina con 3 anni post-laurea o da medici di medicina d'urgenza che avevano partecipato ad un corso didattico e pratico di 4 ore, con sonda lineare da 7.5 MHz sia con scansioni longitudinali che assiali. Risultati Sono stati inclusi ed esaminati novantasette pazienti. 27 (27,8 %) secondo i risultati delle ecografie effettuate dai medici di emergenza avevano un'appendicite. 19 (70.37 %) di loro avevano un'appendicite anche (2015( ) 18:57-62 DOI 10.1007 secondo i risultati dell 'anatomia patologica. 43 (44,3 %) pazienti avevano un'appendicit...

Systematic review and meta‐analysis of the accuracy of MRI to diagnose appendicitis in the general population

“…While ultrasound is a safe and generally effective imaging modality, its utility is limited because it is highly operator‐dependent and has limited sensitivity and specificity for the diagnosis of appendicitis, particularly outside of the pediatric population . Emergency physician‐performed ultrasound has been reported to have sensitivity 44–67%, specificity 85–98%, and accuracy 67%, although this specifically relates to clinicians with limited training in sonography . However, one study reports that even formal ultrasound performed by medical sonographers was unable to visualize the appendix in 45% of cases, yielding sensitivity 51.8% and specificity 81.4% .…”

“…6 Emergency physician-performed ultrasound has been reported to have sensitivity 44-67%, specificity 85-98%, and accuracy 67%, although this specifically relates to clinicians with limited training in sonography. 7,8 However, one study reports that even formal ultrasound performed by medical sonographers was unable to visualize the appendix in 45% of cases, yielding sensitivity 51.8% and specificity 81.4%. 9 Further, although the test accuracy of ultrasound in the case of pediatric abdominal pain concerning appendicitis has long been viewed as superior to that of adults, the sensitivity of ultrasound has been reported to be as low as 35% in centers that do not use the technology often.…”

Diagnostic Value and Effect of Bedside Ultrasound in Acute Appendicitis in the Emergency Department

“…Although this was a well‐designed study with a well‐structured training program, the POCUS performers were inexperienced physicians in terms of using bedside US and sample size of the study was small. In another study, Fathi et al . found a sensitivity and specificity of 44.18 and 85.18%, respectively.…”

“…This study shows that focused right lower quadrant US performed by EPs is highly sensitive and specific in the diagnosis of AA, and POCUS, with clinically important EPs’ clinical decision making. Previous studies reported the sensitivity and the specificity of bedside US performed by EPs in the diagnosis of AA as being between 39 to 96.4 and 67.3% to 98.4%, respectively . In a study combining POCUS and scoring systems, the sensitivity and specificity of POCUS for the diagnosis of AA were 73.3 and 67.3%, respectively .…”

Investigating Diagnostic Value of Ultrasonography in Acute Appendicitis

“…[ 21 ] Another study assessed the ultrasound diagnostic accuracy with graduated compression techniques in emergency situation at the patient's bed, but its sensitivity was low and was recommended to be combined with clinical and laboratory findings. [ 22 ]…”