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type: UserItem
resource: Diagnostic accuracy of a pragmatic, ultrasound-based approach to adult patients with suspected acute appendicitis in the ED
tagged: UserTag
  label: *Appendicitis/diagnostic imaging
tagged: UserTag
  label: Acute Disease
tagged: UserTag
  label: Adult
tagged: UserTag
  label: Emergency Service, Hospital
tagged: UserTag
  label: Humans
tagged: UserTag
  label: Retrospective Studies
tagged: UserTag
  label: Sensitivity and Specificity
tagged: UserTag
  label: Ultrasonography/methods
tagged: UserTag
  label: abdomen
tagged: UserTag
  label: diagnosis
tagged: UserTag
  label: ultrasonography

Diagnostic accuracy of a pragmatic, ultrasound-based approach to adult patients with suspected acute appendicitis in the ED
type: AcademicArticle
abstract: BACKGROUND: Systematic imaging reduces the rate of missed appendicitis and negative appendectomies in patients with suspected acute appendicitis (AA). Little is known about the utility of ultrasound as a first diagnostic measure in patients with suspected AA. The aim of this retrospective study is to determine whether ultrasound, performed by emergency physicians or radiologists, can be used as first diagnostic measure in suspected cases to rule out AA and to avoid unnecessary CT. METHODS: We performed a retrospective analysis at the ED of the University Hospital Bern, Switzerland, from 2012 to 2014. Our standard protocol is that all adult patients suspected of appendicitis receive an ultrasound as their first imaging test, either by an emergency physician or a radiologist. The test characteristics of conclusive and inconclusive ultrasound exams were compared with a pragmatic gold standard. RESULTS: The study included 508 patients with suspected AA. 308 patients (60.4%) had a conclusive ultrasound. Among these, sensitivity for appendicitis was 89.6% (95% CI 82.1% to 94.3%), specificity 93.8% (89.1% to 96.6%), the positive predictive value was 87.98 (80.84 to 92.71) and the negative predictive value was 94.65 (91.18 to 96.80). The remaining 200 (39.4%) patients had an inconclusive ultrasound exam. 29% (59/200) of these patients ultimately had appendicitis. Less experienced emergency physician sonographers came to a definitive conclusion in 48.1% (95% CI 36.9% to 59.5%), experienced emergency physician sonographers in 76.0% (68.4% to 82.5%) and radiologists in 52.4% (44.5% to 60.2%). CONCLUSION: A conclusive ultrasound of the appendix performed by either emergency physicians or radiologists is a sensitive and specific exam to diagnose or exclude AA in patients with suspected AA. Because of 6% false negative exams, clinical follow-up is mandatory for patients with negative ultrasound. An inconclusive ultrasound warrants further imaging or a follow-up visit, since 29% o…
pages: 931-936
doi: 10.1136/emermed-2019-208643
source: 35301219
creator: Person
author list: Person
is part of: Issue
  date: 2022-03-19
  volume: 39
  issue: 12
  is part of: Emerg Med J
    type: Journal
    issn: 1472-0213 (Electronic) 1472-0205 (Linking)

Person
given name: B.
surname: Lehmann

Person
given name: U.
surname: Koeferli

Person
given name: T. C.
surname: Sauter

Person
given name: A.
surname: Exadaktylos

Person
given name: W. E.
surname: Hautz