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Diagnostic Accuracy of Acute Appendicitis by Ultrasound in Hospital Emergency
Diagnostic Accuracy of Acute Appendicitis by Ultrasound in Hospital Emergency
ir
Original Article (Pages: 8787-8793)
Abstract
Background
Acute appendicitis is the most common medical condition requiring immediate abdominal surgery.
Medical ultrasound is a non-intrusive, non-expensive and available diagnostic method. In this study,
the accuracy of ultrasound in diagnosis of acute appendicitis in hospital emergency was evaluated.
Materials and Methods
This retrospective cohort study was performed at Ahvaz Imam Khomeini hospital (Ahvaz city, Iran).
The records of outpatient and inpatient of this hospital were studied to extract demographic
information about the patients and radiological reports indicating the occurrence or exclusion of acute
appendicitis and post-appendectomy report to allow for results comparison. Patient from 5-70 years
included, with clinical suspicious to acute appendicitis, pathologic report also reviewed as gold
standard of diagnosis.
Results
A total of 163 study subjects met the inclusion criteria, the age of the subjects ranged from 6 to 63
years. The accuracy, sensitivity and specificity were 98.1, 96 and 100%, respectively. The positive
predictive value was 100%, while the negative predictive value was 82.35%. Diagnostic accuracy was
100% for the under-15 age group and 94.06% for the above 15 years age group.
Conclusion
The results showed that the medical ultrasound reports could be considered more credible in
diagnosing acute appendicitis in under-15 male subjects which paves the way for more accurate
planning of treatment and presenting patients with abdominal pains for surgery.
*Please cite this article as: Mohammad Ghasem Hanafi, Afshin Shiri. Diagnostic Accuracy of Acute
Appendicitis by Ultrasound in Hospital Emergency. Int J Pediatr 2019; 7(1): 1795-1802. DOI:
10.22038/ijp.2018.33708.2978
*Corresponding Author:
Mohammad ghasem Hanafi, Golestan Blvd., P.C. Box# 6135733119, Ahvaz, Iran. Fax: +98 6133743034.
Email: gasemhanafi@gmail.com
Received date: Jun.15, 2018; Accepted date: Aug. 12, 2018
gender, age, the initial radiological reports Of the 100 assessed female individuals, 85
indicating the occurrence or non- subjects had a positive medical ultrasound
occurrence of acute appendicitis and post- and consequently underwent surgery
appendectomy report to allow for the during which evidence of appendicitis was
comparison of results. observed. In 15 cases where the evidence
of appendicitis ultra-sonography evidence
2-5. Analysis
was not observed, we had 6 misdiagnoses
Chi-squared and T-tests were administered (Table.2 Diagnostic accuracy). These
using SPSS software version 20 to patients were relieved of their pains after
examine, assess and measure the administering medical abdominal
sensitivity, specificity, positive predicted treatments and released later while 4 cases
value (PPV) and negative predicted value were false negative.
(NPV) of the collected data. The level of
significance for the above-mentioned tests 3-2. Results in the studied male subjects
was set at p˂0.05. Of the 63 assessed male individuals, 44
(70%) individuals had a positive medical
3- RESULTS ultrasound which was compatible with in-
A total of 163 study subjects met the surgery diagnoses. In the remaining 19
inclusion criteria (Figure.1, STARD flow cases which were negative based on
diagram); 61.34% (n=100) of the study medical ultrasound examinations, there
subjects were female. The age of the were two cases of incorrect medical
subjects ranged from 6 to 63 years ultrasound results (Table.2, Diagnostic
(Table.1 Patient Characteristics). For accuracy).
better analyses of the study population, the 3-3. Results in the studied under-15
subjects were categorized into two groups years old subjects
of under 15 years of age and over 15. A
This category covered 93 patients, the
total of 93 participants were under 15
medical ultrasound results and post-
years i.e. 57.05% of the whole population
surgery diagnoses which were compatible
while 70% of participants were over 15
(Table.2, Diagnostic accuracy).
years of age or 42.95% of the population.
The accuracy, sensitivity and specificity 3-4. Results in the studied over-15 years
were 98.1, 96 and 100%, respectively. The old subjects
positive predictive value was 100%, and This category covered 70 patients with 50
the negative predictive value was 82.35% cases of positive medical ultrasound
(Table.2, Diagnostic accuracy). The results which were compatible with in-
following results were obtained for all the surgery diagnoses. The remaining 20
patients based on the initial medical medical ultrasound results were negative
Ultrasound and by comparing it with the for acute appendicitis, 6 of which were
post-surgery diagnoses of surgeons. misdiagnoses (false negative) (Table.2,
3-1. Results in the studied female Diagnostic accuracy).
subjects
Table-2: Sensitivity and Specificity Values for Age and gender With the Use of Ultrasound for the
Diagnosis of Acute Appendicitis
Number of Sensitivity Specificity Diagnostic
Patients PPV (%) NPV (%)
patient (%) (%) accuracy (%)
Female 100 89.4 100 100 73.33 94.7
Male 63 95.6 100 100 89.4 97.8
15˃years 93 100 100 100 100 100
15≤years 70 89.2 100 100 70 94.06
Total 163 96 100 100 82.35 98.1
methods for acute appendicitis. The American Department has a High Rate of Nondiagnostic
surgeon 2013, 79(1):101-6. Studies. The Journal of emergency medicine
2017, 52(6):833-38.
21. Sezer TO, Gulece B, Zalluhoglu N,
Gorgun M, Dogan S. Diagnostic value of 29. Gungor F, Kilic T, Akyol KC, Ayaz
ultrasonography in appendicitis. Advances in G, Cakir UC, Akcimen M, et al. Diagnostic
clinical and experimental medicine : official Value and Effect of Bedside Ultrasound in
organ Wroclaw Medical University 2012, Acute Appendicitis in the Emergency
21(5):633-36. Department. Academic emergency medicine :
official journal of the Society for Academic
22. Drake FT, Kotagal M, Simmons LE,
Emergency Medicine 2017, 24(5):578-86.
Parr Z, Dighe MK, Flum DR. Single
institution and statewide performance of 30. Hwang ME. Sonography and
ultrasound in diagnosing appendicitis in Computed Tomography in Diagnosing Acute
pregnancy. The journal of maternal-fetal & Appendicitis. Radiologic technology 2018,
neonatal medicine : the official journal of the 89(3):224-37.
European Association of Perinatal Medicine,
31. Giljaca V, Nadarevic T, Poropat G,
the Federation of Asia and Oceania Perinatal
Nadarevic VS, Stimac D. Diagnostic Accuracy
Societies, the International Society of Perinatal
of Abdominal Ultrasound for Diagnosis of
Obstet 2015, 28(6):727-33.
Acute Appendicitis: Systematic Review and
23. Kotagal M, Richards MK, Chapman Meta-analysis. World journal of surgery 2017,
T, Finch L, McCann B, Ormazabal A, et al. 41(3):693-700.
Improving ultrasound quality to reduce
32. Zhang H, Liao M, Chen J, Zhu D,
computed tomography use in pediatric
Byanju S. Ultrasound, computed tomography
appendicitis: the Safe and Sound campaign.
or magnetic resonance imaging - which is
American journal of surgery 2015, 209(5):896-
preferred for acute appendicitis in children? A
900; discussion 900.
Meta-analysis. Pediatric radiology 2017,
24. Lofvenberg F, Salo M. Ultrasound for 47(2):186-96.
Appendicitis: Performance and Integration
33. Ferrarese A, Falcone A, Solej M,
with Clinical Parameters. BioMed research
Bono D, Moretto P, Dervishi N, Andrea V,
international 2016, 2016:5697692.
Enrico S, Nano M, Martino V: Surgeon's
25. Aspelund G, Fingeret A, Gross E, clinical valuation and accuracy of ultrasound
Kessler D, Keung C, Thirumoorthi A, Oh PS, in the diagnosis of acute appendicitis: A
et al: Ultrasonography/MRI versus CT for comparison with intraoperative evaluation.
diagnosing appendicitis. Pediatrics 2014, Five years experience. International journal of
133(4):586-93. surgery (London, England) 2016, 33 Suppl
1:S45-50.
26. Bachur RG, Dayan PS, Bajaj L,
Macias CG, Mittal MK, Stevenson MD, et al: 34. Koo HS, Kim HC, Yang DM, Kim
The effect of abdominal pain duration on the SW, Park SJ, Ryu JK: Does computed
accuracy of diagnostic imaging for pediatric tomography have any additional value after
appendicitis. Annals of emergency medicine sonography in patients with suspected acute
2012, 60(5):582-590 e583. appendicitis? Journal of ultrasound in
medicine : official journal of the American
27. Leeuwenburgh MM, Wiezer MJ,
Institute of Ultrasound in Medicine 2013,
Wiarda BM, Bouma WH, Phoa SS,
32(8):1397-1403.
Stockmann HB, et al: Accuracy of MRI
compared with ultrasound imaging and 35. Shirazi AS, Sametzadeh M,
selective use of CT to discriminate simple Kamankesh R, Rahim F: Accuracy of
from perforated appendicitis. The British sonography in diagnosis of acute appendicitis
journal of surgery 2014, 101(1):e147-55. running. Pakistan journal of biological
sciences : PJBS 2010, 13(4):190-93.
28. Alter SM, Walsh B, Lenehan PJ, Shih
RD. Ultrasound for Diagnosis of Appendicitis
in a Community Hospital Emergency