Diagnostic Accuracy of Fact in Clinically Suspected Cases of Acute Appendicitis in Adolescents and Adults, Taking Surgical Findings as Gold Standard
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Objective: to evaluate the diagnostic accuracy of FACT in clinically suspected cases of Acute Appendicitis in adolescents and adults, taking surgical findings as gold standard. Methods: A total of 335 patients referred from emergency department with clinical suspicion of acute appendicitis were enrolled at Radiology Department, Services Hospital Lahore, from April, 2016 to October, 2016. FACT was performed using multi-slice CT. The cases underwent surgery and the results were recorded. The results of Focused Abdominal Computed Tomography and surgery were compared taking surgical findings as gold standard. Results: The mean age of patients in our study was 23.01 ± 5.479. We found 278 true-positives, 50 true-negatives, 04 false-negatives results, with sensitivity of 98.6%, a specificity of 94.3%, a PPV of 98.9%, a NPV of 92.6%, and an accuracy of 98%. An alternate diagnosis was made by FACT in 40 patients (11.9%). Conclusion: FACT (focused non-enhanced abdominal computed tomography) is a highly accurate imaging modality for diagnosis of acute appendicitis in adolescents and adults. Keywords: Focused Abdominal CT, Acute Appendicitis, FACT, Diagnostic AcuuracyKeywords:
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Objective: To evaluate the efficacy of non -enhanced helical computed tomography scan in patients with acute right lower quadrant pain and diagnosing acute appendicitis. Method: A total number of 70 patients presented with right lower quadrant pain, suspected to have appendicitis were referred by emergency and surgical departments for a non -enhanced helical computed tomography scan. The primary computed tomography criteria for diagnosing acute appendicitis were a distended appendix greater than 6 mm in maximal diameter, appendiceal wall thickening, and free peritoneal fluid. Prospective diagnoses based on computed tomography findings were compared with surgical results and clinical follow -up. Results: Acute appendicitis was diagnosed in 30 of the 70 patients (43%). Of the 30 patients with a computed tomography diagnosis of acute appendicitis, 27 (39%) had acute appendiciti s proven by surgery and pathology. Twenty-two (31%) patients had a normal computed tomography study and 18 (26%) patients had non-appendiceal pathologies. There were 27 true-positives, 38 true negatives, 3 false positives, and 2 false negatives. Non -contrast helical computed tomography had a sensitivity of 90%, specificity of 95%, and accuracy of 95%. Conclusion: This study shows that non-enhanced Computed tomography is a useful test to diagnose appendicitis in patients with acute abdominal pain in the right lower quadrant.
Acute abdominal pain
Helical computed tomography
Quadrant (abdomen)
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Abdominal ultrasound
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Background and Aims: To assess the accuracy of computed tomography in diagnosing acute appendicitis with a special reference to radiologist experience. Material and Methods: Data were collected prospectively in our randomized controlled trial comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (APPAC trial, NCT01022567). We evaluated 1065 patients who underwent computed tomography for suspected appendicitis. The on-call radiologist preoperatively analyzed these computed tomography images. In this study, the radiologists were divided into experienced (consultants) and inexperienced (residents) ones, and the comparison of interpretations was made between these two radiologist groups. Results: Out of the 1065 patients, 714 had acute appendicitis and 351 had other or no diagnosis on computed tomography. There were 700 true-positive, 327 true-negative, 14 false-positive, and 24 false-negative cases. The sensitivity and the specificity of computed tomography were 96.7% (95% confidence interval, 95.1–97.8) and 95.9% (95% confidence interval, 93.2–97.5), respectively. The rate of false computed tomography diagnosis was 4.2% for experienced consultant radiologists and 2.2% for inexperienced resident radiologists (p = 0.071). Thus, the experience of the radiologist had no effect on the accuracy of computed tomography diagnosis. Conclusion: The accuracy of computed tomography in diagnosing acute appendicitis was high. The experience of the radiologist did not improve the diagnostic accuracy. The results emphasize the role of computed tomography as an accurate modality in daily routine diagnostics for acute appendicitis in all clinical emergency settings.
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Abstract Objective The aim of this study was to assess the diagnostic accuracy of ED doctors with variable training levels in detecting acute appendicitis, without access to advanced imaging in admitted patients with acute abdominal pain in a university hospital of Hong Kong. Methods A retrospective analysis was performed on data collected from prospectively identified patients presenting to the ED with acute abdominal pain and admitted to either a surgical or emergency medical ward between December 2011 and October 2012. Their ED diagnoses with regard to acute appendicitis status were compared with their final diagnoses on discharge from hospital. The gold standard was a histopathological diagnosis of acute appendicitis. The diagnostic accuracy was compared against that generally achieved by computed tomography (CT) scanning in other studies (93–98%), the best diagnostic test currently available for acute appendicitis. A good diagnostic test should have an overall accuracy rate of at least 95%. Results A total of 1653 patients were included in the study. The sensitivity, specificity, positive predictive value and negative predictive value of ED physicians’ diagnosis of acute appendicitis were 81% (73–87%), 84% (82–86%), 31% (28–34%) and 98% (97–99%), respectively, giving an overall diagnostic accuracy of 84% (82–85%). The overall accuracy for separate female and male cohorts were 79% (76–82%) and 89% (83–91%), respectively. Conclusions Diagnostic accuracy of emergency doctors with variable training levels and no access to advanced imaging in a Hong Kong hospital in detecting appendicitis in patients with acute abdominal pain is higher in male patients than in female patients, but lower than that achieved by CT scanning.
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Ultrasound is a widely used technique in the diagnosis of acute appendicitis; nevertheless, its utilization still remains controversial.The accuracy of the Ultrasound technique in the diagnosis of acute appendicitis in the adult patient, as shown in the literature, was searched for.The gold standard for the diagnosis of appendicitis still remains pathologic confirmation after appendectomy. In the published literature, graded-compression Ultrasound has shown an extremely variable diagnostic accuracy in the diagnosis of acute appendicitis (sensitivity range from 44% to 100%; specificity range from 47% to 99% ). This is due to many reasons, including lack of operator skill, increased bowel gas content, obesity, anatomic variants, and limitations to explore patients with previuos laparotomies.Graded-compression Ultrasound still remains our first-line method in patients referred with clinically suspected acute appendicitis: nevertheless, due to variable diagnostic accuracy, individual skill is requested not only to perform a successful exam, but also in order to triage those equivocal cases that, subsequently, will have to undergo assessment by means of Computed Tomography.
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Triage
Interventional radiology
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Objectives The aim of this study was to compare the diagnostic accurateness of ultrasound (US) with that of multidetector computed tomography (MDCT) for the diagnosis of appendicitis in patients with doubted acute appendicitis (AA).Patients and methods A retrospective study was carried out on 110 patients of all age groups in the period between November 2014 and January 2016. All patients presented to the emergency department in our institute with suspected diagnosis of AA using sonography and MDCT.Results US diagnosed correctly AA in 70/75 (93.3%) cases confirmed on histopathology. Computed tomography diagnosed correctly AA in 74/75 (98.6%) cases that confirmed on operation and by histopathology.Conclusion MDCT has mild superiority to US in the diagnosis of AA; however, US with expert hands and newer US machines have high sensitivity and specificity in the diagnosis, and without the hazards of radiation.
Histopathology
Multidetector computed tomography
Abdominal ultrasound
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To determine the diagnostic accuracy and the clinical impact of ultrasound (US) and computed tomography (CT) in diagnosing appendicitis, and to evaluate the impact of laboratory tests on the treatment of acute appendicitis.All patients who, during 2005, underwent an acute ultrasound or CT investigation due to suspected appendicitis, or were diagnosed and/or surgically treated for appendicitis at Umeå University Hospital, Umeå, were included. The type of radiological investigation, its findings, the choice of treatment, final diagnosis, C-reactive protein (CRP), leukocyte particle count (LPC), body temperature, age, and sex were recorded for each patient. The histological result from surgery was considered the gold standard.The material included 305 cases with an overall appendicitis prevalence of 58%. Fifty-two percent of the patients were female. The mean age was 29 years, with a total range of 2-94 years. Twenty percent (60/305) underwent a CT investigation, 40% (123/305) underwent an US investigation, 5% (14/305) underwent both a CT and an US investigation, and 35% (108/305) of patients did not undergo any radiological investigation at all. The sensitivities and specificities were 91% and 94% for CT, and 83% and 98% for US, respectively. The positive likelihood ratio was 15.1 and 45.5 for CT and US, and the negative likelihood ratio was 0.09 and 0.18 for CT and US, respectively. It was not possible to visualize the appendix in 31% of patients examined with US. The prevalence of appendicitis in this group was the same as the prevalence among patients where it was possible to see the appendix, i.e., 35%. The mean CRP for all patients with appendicitis was 59 (95% CI 10-491) mg/l, and the mean LPC was 11.1 (95% CI 2.6-28.1) x10(-9)/l. The mean LPC level was significantly higher for the appendicitis patients. Body temperature could not significantly verify or exclude appendicitis. The overall negative appendectomy rate was 9% (16/176), and it was higher in women, i.e., 11% (9/79). The negative appendectomy rate was slightly higher in the group that was examined by CT and/or US, i.e., 12% (8/69) compared to 7% (8/107) in the group not examined radiologically.Diagnostic accuracy was high for US as well as for CT. US was better for diagnosing positive findings, while CT was better for excluding diagnosis of appendicitis. The diagnostic accuracy of LPC, CRP, and body temperature was low. By combining findings from the radiological examination with the results from the clinical examination and laboratory values, a low negative appendectomy rate can be achieved.
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