Application of scoring systems with point-of-care ultrasonography for bedside diagnosis of appendicitis.
BACKGROUND
Appendicitis is a common disease requiring surgery. Bedside ultrasound (BUS) is a core technique for emergency medicine (EM). The Alvarado score is a well-studied diagnostic tool for appendicitis. This study aimed to investigate the relationship between patients' symptoms, Alvarado score and ultrasound (US) findings, as performed by emergency physicians (EPs) and radiologists, of patients with suspected appendicitis.


METHODS
Three EM specialists underwent the BUS course and core course for appendicitis assessment. Patients suspected of having appendicitis were selected and their Alvarado and modified (m) Alvarado scores calculated. The specialists performed the BUS. Then, patients were given a formal US and surgery consultation if necessary. Preliminary diagnoses, admission or discharge from the emergency department (ED) and final diagnosis were documented. The patients were also followed up after discharge from the hospital.


RESULTS
The determined cut-off value was 2 for Alvarado and 3 for mAlvarado scores. The sensitivities of the two scores were 100%. Each score was used to rule out appendicitis. The results of EP-performed BUS were as follows: accuracy 70%, sensitivity 0.733, specificity 0.673, + LR 2.24, and - LR 0.40 (95%CI). Radiologists were better than EPs at diagnosing appendicitis and radiologists and EPs were equally strong at ruling out appendicitis by US. When US was combined with Alvarado and mAlvarado scores, EP US+Alvarado/mAlvarado scores <3 and radiology US+Alvarado/mAlvarado scores <4 perfectly ruled out appendicitis.


CONCLUSIONS
BUS performed by EPs is moderately useful in detecting appendicitis. Combined with scoring systems, BUS may be a perfect tool for ruling out decisions in EDs.
Department of Emergency Medicine, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, Karabağlar, İzmir 35150, Turkey.
Erden Erol
EE
Ünlüer
Department of Emergency Medicine, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, Karabağlar, İzmir 35150, Turkey.
Rıfat
R
Urnal
Department of Emergency Medicine, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, Karabağlar, İzmir 35150, Turkey.
Utku
U
Eser
Department of Emergency Medicine, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, Karabağlar, İzmir 35150, Turkey.
Serkan
S
Bilgin
Department of General Surgery, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, Karabağlar, İzmir 35150, Turkey.
Mehmet
M
Hacıyanlı
Department of Radiology, Atatürk Training and Research Hospital, İzmir Katip Çelebi University, Karabağlar, İzmir 35150, Turkey.
Orhan
O
Oyar
Department of Emergency Medicine, Faculty of Medicine, Marmara University, İstanbul, İstanbul 34890, Turkey.
Haldun
H
Akoğlu
Department of Emergency Medicine, Karşıyaka State Hospital, Karşıyaka, İzmir 35520, Turkey.
Arif
A
Karagöz
Alvarado score; Appendicitis; Bedside ultrasound