title: The value of ultrasonography in the diagnosis of appendicitis.
abstract: BACKGROUND
  Ultrasonography is a commonly used investigation in the UK for patients with right iliac fossa pain where the diagnosis of appendicitis is unclear. The published sensitivity and specificity of ultrasonography is higher than the results observed by clinicians in every day practice. The aim of this study was to elucidate the real-world value of ultrasonography in the diagnosis of appendicitis, and its impact on negative appendicectomy rates (NAR).
  
  
  METHODS
  A retrospective multicentre audit was conducted at three UK hospitals over a twelve month period in 2012.
  
  
  RESULTS
  573 patients underwent ultrasonography prior to appendicectomy. The appendix was not visualised in 45% of scans. The sensitivity and specificity of ultrasonography for the diagnosis of appendicitis was 51.8% and 81.4%. The mean NAR was 26.7%, or 18.3% after a positive ultrasound scan.
  
  
  CONCLUSIONS
  In clinical practice at UK centres, ultrasonography commonly does not visualise the appendix, and has a low sensitivity for appendicitis. To reduce the NAR, management options include a return to observation and serial examination, increased use of CT or a commitment to improving the performance of ultrasonography.
authors.affiliation: Wessex Deanery, Southern House, Otterbourne, Winchester, Hampshire, UK. Electronic address: mrnigeldsouza@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: D'Souza
authors.affiliation: Royal Hampshire County Hospital, Winchester, UK.
authors.forename: C
authors.initials: C
authors.lastname: D'Souza
authors.affiliation: Oxford Deanery, UK.
authors.forename: D
authors.initials: D
authors.lastname: Grant
authors.affiliation: Wessex Deanery, Southern House, Otterbourne, Winchester, Hampshire, UK.
authors.forename: E
authors.initials: E
authors.lastname: Royston
authors.affiliation: Department of General Surgery, Bucks NHS Healthcare Trust, Buckinghamshire, UK.
authors.forename: M
authors.initials: M
authors.lastname: Farouk
mesh_terms: D000208:Acute Disease; D000328:Adult; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000000981:diagnostic imaging*; D001065:Appendix / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D017699:Pelvic Pain / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Appendicitis; Sensitivity and specificity; Ultrasonography