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

doi:10.1001/archsurg.1993.01420210103014

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Vol. 128 No. 9, September 1993

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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 diagnosisof acute appendicitis with that of an ultrasonographic examinationof the abdomen.

Design
Prospective trial.

Setting
US Naval Hospital, San Diego, Calif.

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

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

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

Conclusion
The overall accuracy of ultrasonography in the diagnosis ofappendicitis was statistically superior to that of the surgeon'sclinical impression (P<.0001). However, 24% of the patientswith normal ultrasound findings were ultimately found to haveappendicitis at operation, emphasizing the point that ultrasonographycannot be relied on to the exclusion of the surgeon's carefuland 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).

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