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

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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.

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 secondo i risultati dell’anatomia patologica. 43 (44,3 %) pazienti avevano un’appendicite, secondo i risultati dell’anatomia patologica. Solo in 19 (44.18 %) di loro era stata diagnosticata dai medici di emergenza. Lo studio ecografico aveva sensibilità del 44.18 %, specificità del 85.18 %, valore predittivo positivo del 70.37 %, valore predittivo negativo del 65,71 % e accuratezza complessiva del 67.01 % nella diagnosi di appendicite in pazienti clinicamente sospetti per appendicite acuta.

Conclusione

L’ecografia eseguita da un medico di emergenza ha un’accuratezza complessiva accettabile, ma la sua sensibilità è bassa, quindi può aiutare i medici a diagnosticare in emergenza l’appendicite acuta se usata in combinazione con altre valutazioni cliniche e para-cliniche, ma non se esclusiva ed isolata.

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Conflict of interest

The authors (Seyyed Abbas Hasani, Marzieh Fathi, Mohammad Amin Zare, Marzieh Daadpey, Nader Hojati Firoozabadi, Daniyal Lotfi) have no conflict of interest.

Human and animal studies

The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.

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Authors and Affiliations

  1. Rasoul Akram Hospital, Iran University of Medical Sciences, Niyayesh St, Sattarkhan Ave, 14456, Tehran, Iran

    Marzieh Fathi

  2. Emergency Medicine Department, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

    Seyyed Abbas Hasani & Mohammad Amin Zare

  3. Emergency Medicine Resident, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

    Marzieh Daadpey, Nader Hojati Firoozabadi & Daniyal Lotfi

Authors
  1. Marzieh Fathi
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  2. Seyyed Abbas Hasani
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  4. Marzieh Daadpey
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  5. Nader Hojati Firoozabadi
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  6. Daniyal Lotfi
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Correspondence to Marzieh Fathi.

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Fathi, M., Hasani, S.A., Zare, M.A. et al. Diagnostic accuracy of emergency physician performed graded compression ultrasound study in acute appendicitis: a prospective study. J Ultrasound 18, 57–62 (2015). https://doi.org/10.1007/s40477-014-0130-5

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  • DOI: https://doi.org/10.1007/s40477-014-0130-5

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