Abstract
IntroductionAppendicitis is a common condition presenting to the emergency department (ED). Increasingly emergency physicians (EP) are using bedside ultrasound (BUS) as an adjunct diagnostic tool. Our objective is to investigate the test characteristics of BUS for the diagnosis of appendicitis and identify components of routine ED workup and BUS associated with the presence of appendicitis.MethodsPatients four years of age and older presenting to the ED with suspected appendicitis were eligible for enrollment. After informed consent was obtained, BUS was performed on the subjects by trained EPs who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis. They then recorded elements of clinical history, physical examination, white blood cell count (WBC) with polymophonuclear percentage (PMN), and BUS findings on a data form. We ascertained subject outcomes by a combination of medical record review and telephone follow-up.ResultsA total of 125 subjects consented for the study, and 116 had adequate image data for final analysis. Prevalence of appendicitis was 40%. Mean age of the subjects was 20.2 years, and 51% were male. BUS was 100% sensitive (95% CI 87–100%) and 32% specific (95% CI 14–57%) for detection of appendicitis, with a positive predictive value of 72% (95% CI 56–84%), and a negative predictive value of 100% (95% CI 52–100%). Assuming all non-diagnostic studies were negative would yield a sensitivity of 72% and specificity of 81%. Subjects with appendicitis had a significantly higher occurrence of anorexia, nausea, vomiting, and a higher WBC and PMN count when compared to those without appendicitis. Their BUS studies were significantly more likely to result in visualization of the appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid, visualization of the appendix tip, and sonographic Mcburney’s sign (p<0.05). In subjects with diagnostic BUS studies, WBC, PMN, visualization of appendix, appendix diameter >6mm, appendix wall thickness >2mm, periappendiceal fluid were found to be predictors of appendicitis on logistic regression.ConclusionBUS is moderately useful for appendicitis diagnosis. We also identified several components in routine ED workup and BUS that are associated with appendicitis generating hypothesis for future studies.
Highlights
IntroductionAppendicitis is the most common acute abdominal disorder that requires surgery.[1,2] The diagnosis is commonly made on the grounds of a combination of history, physical examination, laboratory tests, and diagnostic imaging findings
Appendicitis is a common condition presenting to the emergency department (ED)
After informed consent was obtained, bedside ultrasound (BUS) was performed on the subjects by trained emergency physicians (EP) who had undergone a minimum of one-hour didactic training on the use of BUS to diagnose appendicitis.They recorded elements of clinical history, physical examination, white blood cell count (WBC) with polymophonuclear percentage (PMN), and BUS findings on a data form
Summary
Appendicitis is the most common acute abdominal disorder that requires surgery.[1,2] The diagnosis is commonly made on the grounds of a combination of history, physical examination, laboratory tests, and diagnostic imaging findings. As these diagnostic steps often take place in a serial fashion in the emergency department (ED), patients suspected of appendicitis tend to stay for prolonged periods of time, requiring considerable staff and physical resources.[3,4,5]. The accuracies of these scores tend to worsen when tested by unaffiliated investigators at different sites.[13,14]
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