title: The Reliability of a Standardized Reporting System for the Diagnosis of Appendicitis.
abstract: OBJECTIVE
  Computed tomography (CT) is a fast and ubiquitous tool to evaluate intra-abdominal organs and diagnose appendicitis. However, traditional CT reporting does not necessarily capture the degree of uncertainty and indeterminate findings are still common. The purpose of this study was to evaluate the reproducibility of a standardized CT reporting system for appendicitis across a large population and the system's impact on radiologists' certainty in diagnosing appendicitis.
  
  
  METHODS
  Using a previously described standardized reporting system, eight radiologists retrospectively evaluated CT scans, blinded to all clinical information, in a stratified random sample of 237 patients from a larger cohort of patients imaged for possible appendicitis (2010-2014). Receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were used to evaluate the diagnostic performance of readers for identifying appendicitis. Two-thirds of these scans were randomly selected to be independently read by a second reader, using the original CT reports to balance the number of positive, negative and indeterminate exams across all readers. Inter-reader agreement was evaluated.
  
  
  RESULTS
  There were 113 patients with appendicitis (mean age 38, 67% male). Using the standardized report, radiologists were highly accurate at identifying appendicitis (AUC=0.968, 95%CI confidence interval: 0.95, 0.99. Inter-reader agreement was >80% for most objective findings, and certainty in diagnosing appendicitis was high and reproducible (AUC=0.955 and AUC=0.936 for the first and second readers, respectively).
  
  
  CONCLUSIONS
  Using a standardized reporting system resulted in high reproducibility of objective CT findings for appendicitis and achieved high diagnostic accuracy in an at-risk population. Predictive tools based on this reporting system may further improve communication about certainty in diagnosis and guide patient management, especially when CT findings are indeterminate.
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA.
authors.forename: Vlad V
authors.initials: VV
authors.lastname: Simianu
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA.
authors.forename: Anna
authors.initials: A
authors.lastname: Shamitoff
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Godwin
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Jabi E
authors.initials: JE
authors.lastname: Shriki
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA.
authors.forename: Frederick T
authors.initials: FT
authors.lastname: Drake
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Ryan B
authors.initials: RB
authors.lastname: O'Malley
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Suresh
authors.initials: S
authors.lastname: Maximin
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bastawrous
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Mariam
authors.initials: M
authors.lastname: Moshiri
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Jean H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cuevas
authors.affiliation: Department of Radiology, University of Washington, Seattle WA.
authors.forename: Manjiri
authors.initials: M
authors.lastname: Dighe
authors.affiliation: Department of Surgery, University of Washington, Seattle, WA.
authors.forename: David
authors.initials: D
authors.lastname: Flum
authors.affiliation: Department of Radiology, University of Washington, Seattle WA. Electronic address: bhargp@uw.edu.
authors.forename: Puneet
authors.initials: P
authors.lastname: Bhargava
mesh_terms: D000328:Adult; D001064:Appendicitis / Q000000981:diagnostic imaging*; D002983:Clinical Competence; D004282:Documentation / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D011873:Radiology Information Systems / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed