title: Diagnostic Accuracy of Emergency Physician-Performed Ultrasound for Acute Appendicitis in a Remote Location.
abstract: BACKGROUND
  Preoperative imaging for suspected acute appendicitis (AA), such as ultrasonography (US), was shown to improve diagnostic accuracy and patient outcomes. Criteria for diagnosis of AA by US are well established and reliable. In previous studies, US assessments were always performed by skilled radiologist physicians. However, a radiologist and computed tomography scanning equipment are not always available in the community hospitals or remote sites of developing countries.
  
  
  OBJECTIVE
  Our aim was to assess a diagnostic pathway using clinical evaluation, routine US performed by an emergency physician, and clinical re-evaluation for patients suspected of having AA.
  
  
  METHODS
  Patients suspected of having AA admitted to the emergency department in a developing country were prospectively enrolled between November 2010 and January 2011. Clinical and US data were studied. A noncompressible appendix with a diameter ≥6 mm was the main US diagnosis criterion.
  
  
  RESULTS
  Among the 104 included patients, surgery was performed on 28. Of the 25 patients with positive US, 22 actually had AA, matching the surgical report. The remaining 76 patients without US appendicitis criteria underwent clinical follow-up and had medical conditions. Sensitivity of US was 88%, specificity was 96%, positive predictive value was 88%, and negative predictive value was 96%. The likelihood ratios for our US assessment highlight the need for a test with enhanced diagnostic accuracy.
  
  
  CONCLUSIONS
  A diagnostic strategy using clinical evaluations, routine US performed by emergency physicians, and clinical re-evaluation of patients with acute abdominal pain is appropriate to provide positive results for the diagnosis and treatment of appendicitis in remote locations.
authors.affiliation: Bataillon de Marins-Pompiers de Marseille, Marseille, France; Hôpital Médico-Chirurgical, Bouffard, Djibouti.
authors.forename: François
authors.initials: F
authors.lastname: Topin
authors.affiliation: Bataillon de Marins-Pompiers de Marseille, Marseille, France.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Thierry
authors.affiliation: Hôpital Médico-Chirurgical, Bouffard, Djibouti; Service des Urgences, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Catrevaux
authors.affiliation: Hôpital Médico-Chirurgical, Bouffard, Djibouti; Service Médical Matignon, Paris, France.
authors.forename: Thibault
authors.initials: T
authors.lastname: Barnoux
authors.affiliation: Hôpital Médico-Chirurgical, Bouffard, Djibouti; Clinique Les Orchidées, Le Port, Réunion.
authors.forename: Paul
authors.initials: P
authors.lastname: Menguy
authors.affiliation: Hôpital Médico-Chirurgical, Bouffard, Djibouti; Hôpital d'Instruction des Armées Desgenettes, Lyon, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Bertani
authors.affiliation: Hôpital Médico-Chirurgical, Bouffard, Djibouti; Hôpital d'Instruction des Armées Laveran, Marseille, France.
authors.forename: Pierre-Laurent
authors.initials: PL
authors.lastname: Massoure
authors.affiliation: Hôpital d'Instruction des Armées Laveran, Marseille, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Geffroy
authors.affiliation: Brigade des Sapeurs-Pompiers de Paris, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Tourtier
authors.affiliation: Hôpital Médico-Chirurgical, Bouffard, Djibouti.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bougère
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000175:diagnosis* / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015730:Djibouti; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods / Q000592:standards*
keywords: Horn of Africa; acute appendicitis; emergency; remote site; ultrasound