Misdiagnosis of Appendicitis and the Use of Diagnostic Imaging

Flum, David R.; McClure, Timothy; Morris, Arden M.; Koepsell, Thomas D.

doi:10.1016/j.jamcollsurg.2005.04.039

Cited by 125 publications

(102 citation statements)

References 24 publications

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“…In that study, the evaluation of the surgeon had a positive predictive value of 83.9%. This data, comparable to that found in the literature, reinforce the importance of clinical symptoms and signs for the diagnosis of acute appendicitis, configuring an index of non-therapeutic interventions in 16.0% of patients, very similar to data cited in the literature 9,10 . In this research, the clinical picture presented typically, with the classical evolution of pain in 80.9% of patients, including those with confirmed diagnosis of acute appendicitis.…”

Section: Results Results Results Resultssupporting

confidence: 88%

“…Similarly, the correct and early diagnosis aims to reduce the most serious cases, accompanied by perforation and peritonitis, which increases the incidence of complications from 3 to 47% 4 . The employment of imaging methods to assist the diagnosis of appendicitis is still far from consensus, as works like the one from Flumen et al 9,28 show that even with the use of ultrasound and CT scan, the rate of nontherapeutic resection persists in expressive percentage (15%), notably in women of reproductive age and patients in extremes of age.…”

Section: Results Results Results Resultsmentioning

confidence: 99%

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Índices diagnósticos da ultrassonografia abdominal na apendicite aguda: influência do gênero e constituição física, tempo evolutivo da doença e experiência do radiologista

Peixoto

Nunes

Gomes

2011

Rev. Col. Bras. Cir.

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Influence of gender and physical constitution, time evolution of the disease and experience of radiologist evolution of the disease and experience of radiologist evolution of the disease and experience of radiologist evolution of the disease and experience of radiologist evolution of the disease and experience of radiologist Índices diagnósticos da ultrassonografia abdominal na apendicite aguda. Índices diagnósticos da ultrassonografia abdominal na apendicite aguda. Índices diagnósticos da ultrassonografia abdominal na apendicite aguda. Índices diagnósticos da ultrassonografia abdominal na apendicite aguda. Índices diagnósticos da ultrassonografia abdominal na apendicite aguda. Influência do gênero e constituição física, tempo evolutivo da doença e Influência do gênero e constituição física, tempo evolutivo da doença e Influência do gênero e constituição física, tempo evolutivo da doença e Influência do gênero e constituição física, tempo evolutivo da doença e Influência do gênero e constituição física, tempo evolutivo da doença e experiência do radiologista experiência do radiologista experiência do radiologista experiência do radiologista experiência do radiologista We prospectively evaluated 156 patients with clinical diagnosis of acute appendicitis who underwent laparoscopic appendectomy and abdominal ultrasonography, together with pathology of the excised appendices. Patients were allocated in relation to BMI in both groups (below or above 25 kg/m 2 ) and radiologists, in three groups according to their professional experience (less than five years, between five and 10 years and more than 10 years). The survey also assessed the influence of gender and time of disease progression using the median of 36 hours. Results Results ResultsResults Results: The sensitivity and specificity of abdominal ultrasonography for diagnosing appendicitis were 64.9 and 72% respectively. Gender, body mass index, length of experience of the radiologists in the three groups and time of onset of symptoms showed no significant differences in the establishment of sonographic diagnosis of acute appendicitis. Conclusion Conclusion Conclusion Conclusion Conclusion: The abdominal ultrasonography showed low sensitivity and specificity and little contribution to the diagnosis of acute appendicitis. Gender, physical constitution, the experience of the radiologist and time of onset of symptoms did not affect the outcome of the sonography.

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Section: Results Results Results Resultssupporting

confidence: 88%

Section: Results Results Results Resultsmentioning

confidence: 99%

Índices diagnósticos da ultrassonografia abdominal na apendicite aguda: influência do gênero e constituição física, tempo evolutivo da doença e experiência do radiologista

Peixoto

Nunes

Gomes

2011

Rev. Col. Bras. Cir.

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“…In addition, laboratory tests, which usually include blood sedimentation rate, C-reactive protein (CRP), coagulation profile, and haemogram, can also be used to detect the presence of inflammation. In some cases, the abdomen is even X-rayed (Flum et al, 2005).…”

Section: Medical Background and Considerations For Analysismentioning

confidence: 99%

A micro-costing approach to estimating hospital costs for appendectomy in a Cross-European context

Schreyögg

2008

Health Econ.

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SUMMARYThis paper aims (a) to determine whether variations in the hospital costs of appendectomy in EU member states are larger within individual countries or between different countries and (b) to explore causes for variations in costs between hospitals and countries. To do so, hospitalisation costs and reimbursement rates for appendectomy were obtained from 54 hospitals in nine European member states based on 1786 cases using a standardised methodology. Regression analysis was performed using hospital characteristics, treatment characteristics, and purchasing power parities (PPP) as explanatory variables in a multilevel framework. The within-country standard error was estimated to h294 (27%), whereas the between-country standard error was h796 (73%). Excluding hospitals in Spain, Hungary, and Poland, which had significantly lower costs than hospitals in the other countries in our analysis, the within-country standard error was h331 (57%) and the between-country standard error dropped to h248 (43%). Regression results show that the treatment decision for open surgery was associated with significantly lower costs, whereas a greater number of beds and a higher staff per bed ratio were associated with significantly higher costs. PPP explained a major part of the between-country variance.

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“…In general, the researchers recommended imaging only when the diagnosis is unclear, and for these cases CT is usually the preferred method of imaging. The same group published a longitudinal study in the Journal of the American College of Surgeons in December 2005 confirming the unchanged rate of negative appendectomy despite increasing use of CT and ultrasound [6].…”

mentioning

confidence: 92%

CT Scans in the Diagnosis of Appendicitis

2006

AMA Journal of Ethics

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Acute appendicitis is responsible for more than 250 000 visits to the emergency room every year, with a roughly 7 percent probability of occurrence over one's lifetime [1]. Although appendicitis is usually diagnosed on the basis of clinical findings, computed tomography (CT) and other imaging modalities have been used when the diagnosis is unclear. The escalating use of CT has led physicians to examine its diagnostic role more closely.

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Misdiagnosis of Appendicitis and the Use of Diagnostic Imaging

Cited by 125 publications

References 24 publications

Índices diagnósticos da ultrassonografia abdominal na apendicite aguda: influência do gênero e constituição física, tempo evolutivo da doença e experiência do radiologista

Índices diagnósticos da ultrassonografia abdominal na apendicite aguda: influência do gênero e constituição física, tempo evolutivo da doença e experiência do radiologista

A micro-costing approach to estimating hospital costs for appendectomy in a Cross-European context

CT Scans in the Diagnosis of Appendicitis

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