 |
|
Detection of Pinpoint Tenderness on the Appendix Under Ultrasonography Is Useful to Confirm Acute Appendicitis
Kuniyasu Soda, MD,PhD;
Kazunari Nemoto, MD;
Shuuichi Yoshizawa, MD;
Taro Hibiki, MD;
Kayoko Shizuya, MD;
Fumio Konishi, MD,PhD
Arch Surg. 2001;136:1136-1140.
Hypothesis Ultrasonography can be efficiently performed using new criteria for the diagnosis of acute appendicitis.
Design Prospective trial.
Patients Eighty-nine patients admitted to the hospital with suspected appendicitis between March 1998 and November 2000.
Intervention At hospital admission, a staff surgeon evaluated each patient and determined whether the patient had appendicitis requiring immediate surgery or another disease. Patients then underwent ultrasonography. A sonographic transducer was placed on the area of maximal tenderness. When the pathological manifestation was depicted, the examiner slipped a fingertip between the transducer and the patient's skin and then pressed the area of depicted pathological manifestation to find pinpoint tenderness. When maximal pinpoint tenderness was noted on the appendix or on pathological manifestations contiguous to the appendix, we diagnosed the condition as appendicitis.
Main Outcome Measures Sensitivity, specificity, positive and negative predictive values, and overall accuracy.
Results The diagnosis of appendicitis by this criteria had a sensitivity of 86.7%, a specificity of 89.7%, a positive predictive value of 94.5%, a negative predictive value of 76.5%, and overall accuracy of 87.6%. All 50 patients with pinpoint tenderness noted on the appendix had appendicitis. The surgeon's initial clinical impression had a sensitivity of 83.3%, a specificity of 44.8%, a positive predictive value of 75.8%, a negative predictive value of 56.5%, and overall accuracy of 70.8%.
Conclusions The efficacy of ultrasonography using the simple criteria was superior to that of the surgeon's initial clinical impression (P<.001). Our ultrasonographic criteria for the diagnosis of appendicitis are simple to use and efficient.
From the Departments of Surgery, Omiya Medical Center, Jichi Medical School, Saitama (Drs Soda and Konishi), and Ishioka Dai-Ichi Hospital, Ibaraki (Drs Soda, Nemoto, Yoshizawa, Hibiki, and Shizuya), Japan.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati
What's this?
RELATED ARTICLES
This Month in Archives of Surgery
Arch Surg. 2001;136(10):1105.
FULL TEXT
Archives of Surgery Reader's Choice: Continuing Medical Education
Arch Surg. 2001;136(10):1214-1215.
FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
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
|
