Retrospective analysis of emergency department ultrasound for acute appendicitis.
OBJECTIVE
To determine whether emergency physicians (EPs) who have skills in the other applications of ultrasound can apply these in appendicitis diagnosis.


METHODS
EPs did not have focused training in bedside ultrasound for appendicitis. We identified patients receiving an ED bedside ultrasound evaluation for appendicitis from our ultrasound log. Criterion reference was radiology ultrasound (RUS), CT scan, or pathology report.


RESULTS
We performed 155 ED ultrasounds for appendicitis. There were 27/155 cases where the ED ultrasound was true positive and agreed with pathology (sensitivity = 39%, 95% CI 28 - 52%). In 42/155 (27%) the ED ultrasound was non-diagnostic (false negative) with pathology positive. In 77 cases the ED ultrasound was true negative with non-visualization of the appendix in concert with non-visualization by RUS or CT scan (specificity = 90%, 95% CI 81-95%). In nine cases (6%), ED ultrasound was falsely positive, compared to CT scan with surgical consult.


CONCLUSIONS
ED ultrasound by EPs prior to focused appendicitis ultrasound training is insufficiently accurate.
Fox
John C
JC
University of California, Irvine Medical Center, Department of Emergency Medicine.
Hunt
Matthew J
MJ
Zlidenny
Alex M
AM
Oshita
Masaru H
MH
Barajas
Graciela
G
Langdorf
Mark I
MI