Sensitivity and specificity of computed tomography and ultrasound for the prediction of acute appendicitis at King Fahad Specialist Hospital in Buraidah, Saudi Arabia

Abstract

Objectives: To determine the sensitivity and specificity of computed tomography (CT) and ultrasound (US) in predicting acute appendicitis in relation to histopathology reports at King Fahad Specialist Hospital in Buraidah, Saudi Arabia. Methods: A retrospective cohort study included 500 medical records of patients diagnosed with acute appendicitis upon admission to King Fahad Specialist Hospital, Buraidah, Saudi Arabia, between January 2015 and January 2017. Results: Of the 200 patients, 187 (93.5%) were diagnosed with acute appendicitis by histopathology. Of these 187 patients, 57 (30.5%) underwent CT and 54 (29%) underwent US. Computed tomography correctly identified 86.0% of the patients as having acute appendicitis and incorrectly identified 14% as not having acute appendicitis. Similarly, US correctly identified 37% of the patients as having acute appendicitis, while the remaining 63% were incorrectly identified as not having acute appendicitis. Thirteen patients (6.5%) did not have acute appendicitis (confirmed by histology report). Six (46.15%) of these 13 patients underwent CT. Five of these 6 (83.3%) were incorrectly diagnosed with acute appendicitis by CT, whereas one of the 6 (16.7%) was identified as a true negative. On the other hand, US correctly identified 100% of the 13 patients as true negative. Conclusion: Computed tomography was shown to have sensitivity 86% and a specificity of 16.7% for the diagnosis of acute appendicitis. On the other hand, US had a sensitivity of 37% and a specificity of 100%. Therefore, we conclude that if imaging needed to confirm the diagnosis of appendicitis, CT is the choice. Ultrasound can be used only to exclude gynecological disorders.

Prediction of acute appendicitis among patients with undifferentiated abdominal pain at emergency department

“…Previous studies have shown that because the ED is a critical staging area for critically ill patients, developing more efficient tools to avoid overcrowding and increase the efficiency of the use of healthcare resources in the ED and ultimately improve the quality of care and health outcomes for ED patients [48][49][50]. The prediction model developed in our study for adults and pediatric ED patients with diagnosed appendicitis is consistent with the goal of establishing a better decision system in ED [51,52].…”

Comparison of Ultrasound and Computed Tomography Scanning Accuracy in Diagnosing Acute Appendicitis at King Abdulaziz University Hospital

“…Meanwhile, the respective values for CT imaging were 95%, 94%, 95%, and 99% [16]. Consequently, Alshebromi and co-workers (2019) reported that US imaging has a sensitivity of 37.0% and specificity of 100.0% while CT imaging has 86.0% and 16.7%, respectively [8]. Reich and co-workers (2011) also compared US and CT imaging in terms of sensitivity and PPV in which results revealed that CT had better sensitivity and PPV of both 100% compared to that of US with sensitivity and PPV of 68.4% and 94.5%, respectively.…”

“…Meanwhile, CT has been significant in decreasing the percentage of unnecessary appendectomies and was accepted as the standard for the evaluation of patients with suspected AA. Lastly, MRI has shown a high accuracy rate in AA detection and usefulness during the inapplicability of radiation, such as for pregnant women and young patients [8].…”

The Use of Procalcitonin in the Diagnosis of Acute Appendicitis: A Systematic Review

“…Nevertheless, Wu et al [ 31 ] also chose to include patients who did not undergo surgical intervention and used CT imaging to aid in diagnosis. The issue with this is that CT scanning for acute appendicitis has been shown to have a sensitivity of roughly 80-90% [ 36 ]. Therefore, there is the concern of potential misdiagnoses which could skew results.…”