title: Integrated clinical-ultrasonographic diagnosis in acute appendicitis.
abstract: OBJECTIVE
  Acute appendicitis is one of the commonest diseases encountered in the field of emergency surgery. If untreated, it can rapidly develop severe complications such as perforation and peritonitis. Surgeons therefore often choose early surgical treatment also when the diagnosis is only probable, facing the risk of performing an elevated amount of unnecessary appendectomies. The aim of this study is to analyse our experience with integrated clinical-ultrasonographic diagnosis in acute appendicitis.
  
  
  METHODS
  From January 1999 to December 2006, 1447 patients underwent clinical examination, leucocyte count, evaluation of C-reactive protein level, and abdominal ultrasonography using graded compression technique and a high frequency probe.
  
  
  RESULTS
  In 368 patients (25%) ultrasonographic diagnosis was acute appendicitis; 8 patients were operated on the basis of clinical evaluation only. Ultrasonography yielded false positive results in 7 cases. In 1079 patients (75%) diagnosis was negative for acute appendicitis; 173 of these patients (12%) received a different diagnosis. The remaining 906 patients underwent clinical follow-up until the symptoms disappeared; there were no complications. In our study, sensitivity of ultrasonography was 98%, specificity 99%, positive predictive value 98%, and negative predictive value 99%. Overall diagnostic accuracy was 99%.
  
  
  CONCLUSIONS
  Integrated diagnosis of acute appendicitis based on clinical evaluation, laboratory tests and ultrasonography is safe and saves resources by preventing unnecessary operations.
authors: Section of General Surgery and Surgical Oncology, Department of Surgery, S.S. Antonio and Biagio and C. Arrigo Hospital, Alessandria, Italy.
authors: M
authors: M
authors: Summa
authors: F
authors: F
authors: Perrone
authors: F
authors: F
authors: Priora
authors: S
authors: S
authors: Testa
authors: R
authors: R
authors: Quarati
authors: G
authors: G
authors: Spinoglio
keywords: Acute appendicitis; Ultrasonography
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