title: The role of preoperative graded compression ultrasound in detecting acute appendicitis and influencing the negative appendectomy rate.
abstract: The diagnosis of acute appendicitis is mainly clinical and is correct in about 80% of patients, but 20-33% present with atypical findings, which resulted in a negative appendectomy rate of 20-30%. The graded compression ultrasound method in the diagnosis of acute appendicitis was reported with a sensitivity of 89%, and specificity of 95%. In this study, we aim to evaluate the graded compression ultrasonography in the diagnosis of acute appendicitis, its influence on the clinical judgment to operate, and its role in lowering the negative appendectomy rate.
  
  
  
  1073 patients treated surgically for acute appendicitis between January 2005 and December 2014 were reviewed. Ultrasound findings, histopathological diagnosis, and positive or negative appendectomy rates were analyzed.
  
  
  
  647 (60.3%) patients were males and 426 (39.7%) females. The mean age was 26.5 years. Positive ultrasound findings were recorded in 892 (83.13%), while negative findings were recorded in 181 (16.87%). Positive appendectomy was recorded in 983 (91.6%), while negative appendectomy was recorded in 90 (8.4%). The sensitivity was 83%, specificity was 100%, and the rate of negative appendectomy was 8.39%.
  
  
  
  Graded compression technique of ultrasound is a useful modality, in addition to the clinical judgment of the surgeon and clinical findings, in detecting true positive cases of acute appendicitis, and thus reducing the negative appendectomy rate. Values of 100% specificity, and 8.4% negative appendectomy rate, or better, could be achieved, when an experienced surgeon and a professional radiologist collaborate in the diagnosis of acute appendicitis.
authors: King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, P.O.Box 65362, Jeddah, 21556, Saudi Arabia. shirah007@ksau-hs.edu.sa.
authors: Bader Hamza
authors: BH
authors: Shirah
authors: Department of General Surgery, Al Ansar General Hospital, Medina, Saudi Arabia.
authors: Hamza Asaad
authors: HA
authors: Shirah
authors: Department of Accidents and Emergency, Al Ansar General Hospital, Medina, Saudi Arabia.
authors: Wael Awad
authors: WA
authors: Alhaidari
authors: Department of Radiology, Al Ansar General Hospital, Medina, Saudi Arabia.
authors: Mohamed Ali
authors: MA
authors: Elraghi
authors: Department of Radiology, Al Ansar General Hospital, Medina, Saudi Arabia.
authors: Mohammad Azam
authors: MA
authors: Chughtai
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: Acute appendicitis; Appendectomy; Diagnosis; Graded compression technique; Negative appendectomy; Ultrasound