"Surgical" ultrasound in suspected acute appendicitis.
BACKGROUND
Ultrasonography (US) by acknowledged experts enhances the diagnostic performance and reduces the rate of negative laparotomies in patients with suspected acute appendicitis (AA).


METHODS
The diagnostic accuracy and clinical impact of routine US performed by surgical residents was prospectively studied in 504 unselected patients admitted for AA. Clinical and US findings were correlated with laparotomy findings and pathological outcome in 135 patients (113 cases with proven AA, prevalence 22.4%) and clinical as well as follow-up data were compared in the remainder.


RESULTS
The overall accuracy, sensitivity, and specificity of the clinical diagnosis of AA were 84.9%, 51.3%, and 94.6% and those of US were 93. 6%, 83.1%, and 96.6%. Joint evaluation of the results from clinical evaluation and US further improved diagnostic performance (accuracy 93.4%, sensitivity 84.1%, specificity 96.2) and significantly reduced the rate of diagnostic errors to 3.4% (p < 0.001) and unnecessary laparotomies to 9.6% (p < 0.01) in patients with suspected AA.


CONCLUSIONS
Ultrasonographic evaluation of the patient with suspected AA is considered to be of value in surgical practice.
Zielke
A
A
Department of General Surgery, Philipps-University of Marburg, Baldinger Strasse, PO-Box 100, 35043 Marburg, Germany.
Hasse
C
C
Sitter
H
H
Kisker
O
O
Rothmund
M
M
D000208:Acute Disease; D000328:Adult; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D007396:Internship and Residency; D007813:Laparotomy; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000706:statistics & numerical data