Systematic Review: Computed Tomography and Ultrasonography To Detect Acute Appendicitis in Adults and Adolescents

Terasawa, Teruhiko; Blackmore, C. Craig; Bent, Stephen; Kohlwes, R. Jeffrey

doi:10.7326/0003-4819-141-7-200410050-00011

Cited by 359 publications

(249 citation statements)

References 108 publications

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“…This is while the diagnostic accuracy of radiologist performed ultrasound study in diagnosis of acute appendicitis still remains conflicting and indistinct, and different studies show different results. As Terasawa et al showed in their review on 14 studies that ultrasonography has a sensitivity of 86 %, specificity of 81 %, positive predictive value of 84 % and a negative predictive value of 85 % in diagnosing acute appendicitis in patients with right lower quadrant pain and suspicious to have acute appendicitis [7], a large meta-analysis (including 22 articles) in Korea found also a sensitivity of 87 % and specificity of 90 % for sonography in acute appendicitis and another review by Pinto et al showed also the acceptable overall accuracy for ultrasound study in diagnosis of acute appendicitis [8]. But there are other studies showing positive predictive value ranging from 46 to 95 % and the negative predictive value ranging from 60 to 97 % for this diagnostic imaging modality [9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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...

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Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…Ultrasonography had an overall sensitivity of 86%, a specificity of 81%. 7 In 2006, a meta-analysis by Doria et al demonstrated that CT imaging featured significantly higher sensitivity and resolution than ultrasound in studies of both children and adults with acute appendicitis. 8 The use of CT for diagnosis of appendicitis in Boston, MA has decreased the chance of finding a normal appendix at surgery from 20% in the pre-CT era to only 3% according to data from the Massachusetts General Hospital.…”

Section: Discussionmentioning

confidence: 99%

Acute pancreatitis Masquerading as acute appendicitis – A diagnostic dilemma

Agrawal

Wasnik

Ray

et al. 2013

Int J of Biomed & Adv Res

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A 28 year old male came to causality with pain in abdomen localising to right iliac fossa for 2 days. There was history of severe nausea but no vomiting and fever. There was no history of similar complaints in the past. Patient was an occasional drinker and denied alcohol consumption for the last 6-7 months. The patient gives history of admission to some hospital with acute abdomen for drinking in excess 8 months back with no details available. There was no significant surgical history.On examination patient was febrile with a temperature of 38.6 and was tachycardic with a pulse of 110 beats per minute. There was severe tenderness in the right iliac fossa with rebound tenderness and peritonism, consistent with a diagnosis of acute appendicitis. (Fig-1) The other systems were normal. It was also kept in mind that he was previously admitted in emergency with acute abdomen probably with acute pancreatitis or acute gastritis. Fig 1-Site of tendernessIJBAR (2013) 04 (09) www.ssjournals.com AbstractWe present a case of acute pancreatitis mimicking as acute appendicitis. There are very few cases in the literature suggesting acute pancreatitis leading to the development of ascities and features of acute appendicitis. The patient was initially diagnosed as complicated acute appendicitis but after thorough workup revealed acute pancreatitis and managed successfully by conservative management.

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“…In his original paper [11] Alvarado recommended an operation for all patients with a scores of 7 or more and observation for patients with scores of 5 or 6. Similarly imaging studies such as ultrasound have an average sensitivity and specificity of around 85-90% [13,14]. Thus incorporating repeated clinical examination, using diagnostic scoring systems and use of imaging has resulted in better diagnostic outcome [15].…”

Section: Discussionmentioning

confidence: 99%

Clinically monitored delay-A valid option in cases with doubtful diagnosis of acute appendicitis

et al. 2010

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Aim To evaluate the effect of delayed surgery after a period of observation in patients with doubtful diagnosis of acute appendicitis in the form of improvement in negative appendectomy rates and the incidence of complications. Materials and methodsOne hundred twelve patients operated with the diagnosis of acute appendicitis between May 2008 to June 2009 were included in this retrospective study. They were divided into two groups based on timing of surgery after admission. These two groups were studied in respect to age, sex, Alvarado score at presentation, ultrasound findings, operative findings, histopathology and postoperative complications. Proportions of negative appendectomies, and complicated appendicitis were analysed statistically.Results Group wise age and sex distribution was comparable. The mean Alvarado score in the group 1 was 7.9 (range, 6-10) where as in those operated later than 12 hours (group 2), it was 4.5 (range, 3-8). Normal appendectomies were significantly (p < 0.05) less in group 2 (1 out of 40) as compared to group 1 (4 out of 72). The number of complicated appendicitis were higher in group 1 (14/72) as compared to group 2 (4/40) but not significantly (p > 0.06). The number of postoperative complications was also high in group 1 (11 vs 2 in group 2). ConclusionIt is better to wait in cases with doubtful initial diagnosis of appendicitis on admission in order to decrease negative appendectomy rates. These patients need to be continuously monitored clinically to prevent complications.

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Systematic Review: Computed Tomography and Ultrasonography To Detect Acute Appendicitis in Adults and Adolescents

Abstract: Computed tomography is probably more accurate than ultrasonography for diagnosing appendicitis in adults and adolescents. Prospective studies that apply gold standard diagnostic testing to all study participants would more reliably estimate the true diagnostic accuracy of these tests.

Cited by 359 publications

References 108 publications

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

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

Acute pancreatitis Masquerading as acute appendicitis – A diagnostic dilemma

Clinically monitored delay-A valid option in cases with doubtful diagnosis of acute appendicitis

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