Recognizing acute appendicitis criteria on abdominal CT: do emergency physicians need a preliminary report?
BACKGROUND
Computed tomography (CT) is invaluable for the diagnosis of acute appendicitis (AA) in the emergency setting when used appropriately with proper risk stratification. The aim of this study is to investigate the capability and accuracy of emergency physicians (EPs) at recognizing AA criteria in intravenous contrast-enhanced abdominal CT and to investigate the level of interobserver agreement among them.


METHODS
Consecutive patients who presented to İzmir University Hospital from January 1, 2014, to December 31, 2014, were evaluated. Patients with histopathologically confirmed AA and had intravenous contrast-enhanced abdominal CT were enrolled. Abdominal CT were interpreted by 4 EPs in a blind fashion. To compare differences in performances between observers, sensitivity, specificity, positive predictive value, negative predictive value, and κ values were calculated. The results were then compared with the radiology department's official reports.


RESULTS
There were 48 patients eligible for the study. Among these patients, 19 were male (41%), with a mean age of 34.4 years (±11.3 years). Five patients were CT-negative appendicitis according to official radiology reports that were accepted as the criterion standard. The best sensitivity and negative predictive values were achieved at criterion "enlargement of the appendix," whereas the least sensitivity was for criterion "lack of opacification in an enlarged appendix."


CONCLUSIONS
The recognition of the CT criteria for AA among EPs is substantial at best, and their ability to recognize the primary criteria for diagnosing AA is good. Emergency physicians have to gain a higher level of expertise to use this invaluable diagnostic tool more efficiently.
Izmir University, Faculty of Medicine, Department of Emergency Medicine, İzmir Üniversitesi Medical Park Hastanesi, Yeni Girne Blv. 1825 Sk. No: 12 Karşıyaka, 35530 İzmir, Turkey. Electronic address: dronderlimon@yahoo.com.
Onder
O
Limon
Izmir University, Faculty of Medicine, Department of Emergency Medicine, İzmir Üniversitesi Medical Park Hastanesi, Yeni Girne Blv. 1825 Sk. No: 12 Karşıyaka, 35530 İzmir, Turkey. Electronic address: deniz.oray@izmir.edu.tr.
Deniz
D
Oray
Izmir University, Faculty of Medicine, Department of Emergency Medicine, İzmir Üniversitesi Medical Park Hastanesi, Yeni Girne Blv. 1825 Sk. No: 12 Karşıyaka, 35530 İzmir, Turkey. Electronic address: cem.ertan@izmir.edu.tr.
Cem
C
Ertan
Izmir University, Faculty of Medicine, Department of Radiology, İzmir Üniversitesi Medical Park Hastanesi, Yeni Girne Blv. 1825 Sk. No: 12 Karşıyaka, 35530 İzmir, Turkey. Electronic address: erkan.sahin@izmir.edu.tr.
Erkan
E
Sahin
Izmir University, Faculty of Medicine, Department of Emergency Medicine, İzmir Üniversitesi Medical Park Hastanesi, Yeni Girne Blv. 1825 Sk. No: 12 Karşıyaka, 35530 İzmir, Turkey. Electronic address: asliaydinoglu@yahoo.com.
Aslı Aydınoğlu
AA
Ugurhan
D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004635:Emergency Medicine / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011871:Radiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult