Accuracy of Ultrasound Exam Performed by Emergency Medicine Versus Radiology Residents in the Diagnosis of Acute Appendicitis

Eur J Emerg Med. 2019 Aug;26(4):272-276. doi: 10.1097/MEJ.0000000000000547.

Abstract

Background: Although the traditional approach to the diagnosis of acute appendicitis (AA) is using clinical methods, experience has shown that strict reliance on clinical data can lead to mismanagement or unnecessary surgery.

Objective: The objective of this study was to determine the total agreement of ultrasound (US) results in AA performed by emergency medicine (EM) versus radiology residents in emergency department.

Patients and methods: In this cross-sectional study, 121 patients with AA suspicion underwent an US exam by both trained EM and radiology residents in emergency department. The training course for EM residents consisted of attending an 8-h-workshop and then practicing an US exam on real patients within a 2-month period. The gold standards were either histopathologic or follow-up results. Total agreement of the results in both specialties was compared.

Results: There were 67 men and 54 women, with a mean age of 33.6 ± 16.1 years (18.2-88.7 years). Fifty-four (44.6%) patients underwent surgery with the initial diagnosis of AA and the rest were evaluated by follow-ups. On the basis of our gold standards, the diagnosis was finally confirmed in 46 (38%) cases. There was a high total agreement in AA diagnosis [96% agreement, κ = 0.90; 95% confidence interval (CI) = 0.81-0.99] between the two groups. The specificity and sensitivity of EM and radiology groups were 99% (95% CI = 93-100), 63% (95% CI = 48-77), 97% (95% CI = 91-100), and 72% (95% CI = 57-84), respectively.

Conclusion: US has a high diagnostic specificity in patients suspected of having AA and EM residents can perform this modality as accurately as radiologists after training in the emergency setting.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Appendicitis / diagnostic imaging*
  • Clinical Competence*
  • Cross-Sectional Studies
  • Early Diagnosis
  • Emergency Medicine / education*
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Hospitals, University
  • Humans
  • Internship and Residency / methods
  • Male
  • Middle Aged
  • Radiology / education*
  • Reproducibility of Results
  • Task Performance and Analysis
  • Ultrasonography, Doppler / methods*
  • Young Adult