Abstract
BackgroundDiagnostic scoring is used to stratify patients with suspected appendicitis into three groups: high, intermediate, and low probability of appendicitis. The stratification can be used for selective imaging to avoid the harms of radiation without compromising diagnostic accuracy.The aim was to study how stratification by Adult Appendicitis Score affects diagnostic performance of imaging studies.MethodsAnalysis of 822 patients who underwent diagnostic imaging for suspected appendicitis was made. Adult Appendicitis Score was used to stratify patients into groups of high, intermediate, and low probability of appendicitis. Diagnostic performance of computed tomography (CT) and ultrasound (US) was compared between these patient groups.ResultsAfter scoring, pre-test probability of appendicitis ranged from 9-16% in low probability group to 75-79% in high probability group in patients who underwent US or CT. Post-test probability of appendicitis after positive CT was 99, 91, and 75% in high probability, intermediate probability and low probability groups, respectively, p < 0.001. After positive US the respective probabilities were 95, 91 and 42%, p < 0.001.ConclusionDiagnostic imaging has limited value in patients with low probability of appendicitis according to Adult Appendicitis Score.
Highlights
Diagnostic scoring is used to stratify patients with suspected appendicitis into three groups: high, intermediate, and low probability of appendicitis
In many institutions, imaging is mandatory in suspected acute appendicitis [4,5,6]
The analysis showed that the added value of imaging in suspected appendicitis depends on the pre-test probability of appendicitis
Summary
Diagnostic scoring is used to stratify patients with suspected appendicitis into three groups: high, intermediate, and low probability of appendicitis. The stratification can be used for selective imaging to avoid the harms of radiation without compromising diagnostic accuracy. The aim was to study how stratification by Adult Appendicitis Score affects diagnostic performance of imaging studies. In many institutions, imaging is mandatory in suspected acute appendicitis [4,5,6]. Routine CT on all patients with suspected appendicitis induces risks of ionizing radiation and contrast medium as well as increased delay to correct diagnosis and treatment [7,8,9,10,11]. US involves no ionizing radiation, but there is great variance in reported diagnostic performance.
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