title: Surgeon's clinical valuation and accuracy of ultrasound in the diagnosis of acute appendicitis: A comparison with intraoperative evaluation. Five years experience.
abstract: BACKGROUND
  Acute appendicitis is the most common cause of acute abdomen in adolescents, with an overall incidence of 7%. Two such tools are used to diagnose acute appendicitis: ultrasound and Computer Tomography imaging. End point of this study was to verify the accuracy of ultrasound imaging in the diagnosis of acute appendicitis with respect to intraoperative observations and the respective clinical and laboratory findings in young and in the elderly.
  
  
  METHODS
  We considered all the appendectomies for acute appendicitis performed between 1 January 2010 and 1 January 2015. We evaluated clinical symptoms, laboratory findings, ultrasound findings, intraoperative signs, and anatomical and pathological findings. In the study we compared the ultrasound and intraoperative findings and then compared these with the respective clinical and laboratory data.
  
  
  RESULTS
  In a comparison of diagnostic accuracy, the difference between clinical and ultrasound examinations was not significant. The differences between the diagnostic accuracy of clinical and laboratory findings and between ultrasound and laboratory investigations were statistically significant.
  
  
  CONCLUSIONS
  We defined white blood cells and C protein levels as non-diagnostic of the type of acute inflammation but rather as indicators of the severity of the inflammatory process. We also agree with the authors who proposed the incorporation of ultrasonography into routine practice in the diagnosis of acute appendicitis, but only and exclusively to support other diagnostic procedures and preferably within emergency departments. A thorough clinical examination of patients with suspected acute appendicitis is still the best diagnostic procedure available to us.
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy. Electronic address: alessia.ferrarese@gmail.com.
authors.forename: Alessia
authors.initials: A
authors.lastname: Ferrarese
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy. Electronic address: alessandrofalcone.md@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Falcone
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy. Electronic address: mariosolej@gmail.com.
authors.forename: Mario
authors.initials: M
authors.lastname: Solej
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy. Electronic address: bonodario9@gmail.com.
authors.forename: Dario
authors.initials: D
authors.lastname: Bono
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of Radiology, Orbassano, Turin, Italy. Electronic address: morettopaolo1978@gmail.com.
authors.forename: Paolo
authors.initials: P
authors.lastname: Moretto
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of Radiology, Orbassano, Turin, Italy. Electronic address: najadadervishi@yahoo.it.
authors.forename: Najada
authors.initials: N
authors.lastname: Dervishi
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of Radiology, Orbassano, Turin, Italy. Electronic address: andrea.veltri@unito.it.
authors.forename: Veltri
authors.initials: V
authors.lastname: Andrea
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy. Electronic address: stefano_e@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Enrico
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy. Electronic address: mario.nano@unito.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Nano
authors.affiliation: University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy. Electronic address: valtermartino.md@gmail.com.
authors.forename: Valter
authors.initials: V
authors.lastname: Martino
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D012189:Retrospective Studies; D066231:Surgeons / Q000592:standards; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
keywords: Acute appendicitis; Appendicitis; Ultrasound