The Diagnostic Accuracy of Abdominal Ultrasonography for Acute Appendicitis and Acute Cholecystitis Performed by Emergency Physicians after Systematic Training for the Abdominal Ultrasonography

Cho, Hyun Joon; Cho, Han Jin; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan; Kim, Dong Pil; Kim, Sin Chul

Abstract

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of abdominal ultrasonography (USG) as performed by emergency physicians (EP) after systematic training and to compare it with the performance of a radiologist.
METHODS
From 4 March, to 3 October, 2006, we enrolled 368 patients with suspected acute appendicitis and 177 patients with suspected acute cholecystitis. During night hours, abdominal USG was performed by EPs who had been trained for more than 2 years (Group I), and during day, it was performed by a radiologist (Group II). In group I, 201 patients were suspected to have acute appendicitis and 103 patients were suspected to have acute cholecystitis. In group II, 167 patients were suspected to have acute appendicitis and 74 patients were suspected to have acute cholecystitis. We reviewed pathology reports and the final diagnoses of all patients after one month. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for each group and then compared the diagnostic accuracy for group I with that of group II using the chisquare test.
RESULTS
With suspected acute appendicitis patients, the sensitivity, specificity, PPV, NPV and accuracy of USG were 92.0%, 85.2%, 88.9%, 89.3%, and 89.1% for group I and 94.2%, 85.7%, 91.6%, 90.0%, and 91.0% for group II. With suspected acute cholecystitis patients, the sensitivity, specificity, PPV, NPV and accuracy of USG were 87.2%, 93.8%, 89.5%, 92.3%, and 91.3% for group I and 92.0%, 93.9%, 88.5%, 95.8%, and 93.2% for group II. There was no significant difference in the diagnostic accuracy between the two groups. (p=0.533, p=0.630)
CONCLUSION
In this study, there was no significant difference between EPs and a radiologist in diagnostic accuracy of abdominal USG. This result suggests that diagnostic abdominal USG for acute abdominal diseases, such as acute appendicitis and acute cholecystitis can be appropriately used as a diagnostic modality by emergency physicians who are properly trained in a systematic educational program.