Accuracy of Emergency Physician's Ultrasonography in the Diagnosis of Acute Appendicitis

Do, Han Ho; Kim, Jae Chul; Kim, Ju Hyon; Kim, Sang Chul; Shin, Tae Yong; Kim, Young Sik; Ha, Young Rock

Abstract

PURPOSE
Ultrasound (US) is one of the most useful modalities to diagnose appendicitis. However, without expert sonographers, the diagnosis of appendicitis via US is limited because it needs much experience to perform properly. Although many emergency physicians (EP) have used US successfully to diagnose appendicitis, there have been few studies comparing the diagnostic accuracy of EP's US with that of experienced radiologists. The purpose of this study is comparing the agreement and the accuracy rate of diagnosis of EP's US with that of experienced radiologists. METHOD: During 2 months, we enrolled 102 patients clinically suspected of having acute appendicitis; then, US was performed by an EP or a radiologist. The US examiner was selected at the time of the patient's arrival. In group I patients US was performed by a senior EP, while in group II patient's, it was performed by a radiologist. If any Group I patients were still in the ED when the radiology department open, US was performed once more by a radiologist. Pathologic reports and final diagnoses were reviewed later. We calculated the sensitivity, the specificity, and the accuracy for each group; then, we compared the accuracies of the two groups and analyzed the agreement of the US diagnoses between the two groups.
RESULTS
Of the 102 patients that were enrolled, 62 patients had US performed by an EP, 66 had US performed by a radiologist, and 26 had US performed by both departments' examiners. The accuracies of US in diagnosing acute appendicitis were 93.5% in group I and 90.9% in group II. The agreement of US diagnoses between the two departments' examiners, in the patients had performed US by both departments, results were significantly similar (Kappa=0.708).
CONCLUSION
This study suggested that a properly educated EP's sonographic diagnosis of appendicitis has the same diagnostic accuracy as that of a radiologist. Thus for reducing complications of acute appendicitis, it would be valuable for an EP to use US in the diagnostic process.