You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


Advertisement

ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | RSS | Access Rights | Sign In


  Vol. 128 No. 9, September 1993 TABLE OF CONTENTS
  Online Only
 •  Online First Table of
Contents
  Papers
 •Online Features
 This Article
 •References
 •Full text PDF
 • Reply to article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (71)
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Delicious Add to Digg Add to Facebook Add to Reddit Add to Technorati Add to Twitter What's this?

Accuracy of Ultrasound in the Diagnosis of Acute Appendicitis Compared With the Surgeon's Clinical Impression

CDR David S. Wade, MC, USN; Stephen E. Morrow, MD; Zubin N. Balsara, MD; Thomas K Burkhard, MD; Walter B. Goff, DO

Arch Surg. 1993;128(9):1039-1046.


Abstract



Objective
To compare the accuracy of the surgeon's clinical diagnosis of acute appendicitis with that of an ultrasonographic examination of the abdomen.

Design
Prospective trial.

Setting
US Naval Hospital, San Diego, Calif.

Patients
One hundred ten patients admitted to the hospital with suspected appendicitis from May 1990 to June 1992.

Intervention
Symptoms and signs for each patient were recorded, along with the surgeon's clinical impression of immediate surgery or observation. The patient then underwent an ultrasound examination performed by a staff radiologist. On the basis of the ultrasound findings the patient was placed into one of three categories: appendicitis, normal examination results, or other conditions. Patients with an ultrasound-based diagnosis of appendicitis proceeded to the operation, regardless of the surgeon's clinical impression. Those with other conditions diagnosed with ultrasonography were treated as was appropriate for the condition.

Results
The ultrasound-derived diagnosis of appendicitis had a sensitivity of 85.5%, a specificity of 84.4%, a positive predictive value of 88.3%, a negative predictive value of 80.1%, and an overall accuracy of 85.0%. The surgeon's clinical impression at the time of admission had a sensitivity of 62.9%, a specificity of 82.2%, a positive predictive value of 82.9%, a negative predictive value of 61.7%, and an overall accuracy of 71.2%.

Conclusion
The overall accuracy of ultrasonography in the diagnosis of appendicitis was statistically superior to that of the surgeon's clinical impression (P<.0001). However, 24% of the patients with normal ultrasound findings were ultimately found to have appendicitis at operation, emphasizing the point that ultrasonography cannot be relied on to the exclusion of the surgeon's careful and repeated evaluation.

(Arch Surg. 1993;128:1039-1046)



Author Affiliations



From the Departments of Surgery (Drs Wade and Morrow) and Radiology (Drs Balsara, Burkhard, and Goff), US Naval Hospital, San Diego, Calif; and the Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Md (Drs Wade and Morrow).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Delicious Delicious   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Abdominal pain
Sadiq et al.
BMJ 2011;343:d4444-d4444.
FULL TEXT  

Management of suspected appendicitis in children
Acheson and Banerjee
EDUCATION AND PRACTICE 2010;95:9-13.
ABSTRACT | FULL TEXT  

CT Evaluation of Appendicitis and Its Complications: Imaging Techniques and Key Diagnostic Findings
Pinto Leite et al.
Am. J. Roentgenol. 2005;185:406-417.
ABSTRACT | FULL TEXT  

Systematic Review: Computed Tomography and Ultrasonography To Detect Acute Appendicitis in Adults and Adolescents
Terasawa et al.
ANN INTERN MED 2004;141:537-546.
ABSTRACT | FULL TEXT  

Selective Imaging Strategies for the Diagnosis of Appendicitis in Children
Garcia Pena et al.
Pediatrics 2004;113:24-28.
ABSTRACT | FULL TEXT  

The Diagnosis of Appendicitis: An Evolving Paradigm
Ziegler
Pediatrics 2004;113:130-132.
FULL TEXT  

Effect of an Imaging Protocol on Clinical Outcomes Among Pediatric Patients With Appendicitis
Pena et al.
Pediatrics 2002;110:1088-1093.
ABSTRACT | FULL TEXT  

Detection of Pinpoint Tenderness on the Appendix Under Ultrasonography Is Useful to Confirm Acute Appendicitis
Soda et al.
Arch Surg 2001;136:1136-1140.
ABSTRACT | FULL TEXT  

Computed Tomography and Ultrasonography in the Diagnosis of Appendicitis: When Are They Indicated?
Wilson et al.
Arch Surg 2001;136:670-675.
ABSTRACT | FULL TEXT  

Computed Tomography in Diagnosing Suspected Appendicitis
Lawrence; et al.
Pediatrics 2001;107:1231-1231.
FULL TEXT  

Unenhanced Limited CT of the Abdomen in the Diagnosis of Appendicitis in Children: Comparison with Sonography
Lowe et al.
Am. J. Roentgenol. 2001;176:31-35.
ABSTRACT | FULL TEXT  

Evaluation of Suspected Appendicitis in Children Using Limited Helical CT and Colonic Contrast Material
Mullins et al.
Am. J. Roentgenol. 2001;176:37-41.
ABSTRACT | FULL TEXT  

Costs and Effectiveness of Ultrasonography and Limited Computed Tomography for Diagnosing Appendicitis in Children
Garcia Pena et al.
Pediatrics 2000;106:672-676.
ABSTRACT | FULL TEXT  

Radiologists' Confidence in Interpretation of Sonography and CT in Suspected Pediatric Appendicitis
Pena and Taylor
Am. J. Roentgenol. 2000;175:71-74.
ABSTRACT | FULL TEXT  

Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children
Pena et al.
JAMA 1999;282:1041-1046.
ABSTRACT | FULL TEXT  

Effect of Computed Tomography on Patient Management and Costs in Children With Suspected Appendicitis
Pena et al.
Pediatrics 1999;104:440-446.
ABSTRACT | FULL TEXT  

Does This Patient Have Appendicitis?
Wagner et al.
JAMA 1996;276:1589-1594.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1993 American Medical Association. All Rights Reserved.