IMPORTANCE OF CLINICAL ASSESSMENT IN DIAGNOSIS OF ACUTE APPENDICITIS AND ITS ROLE IN DECREASING NEGATIVE APPENDICECTOMY RATE
Abstract
Background: Appendicitis is a common diagnosis, but is by no means a simple one to establish. It isimpractical to have a definitive preoperative diagnosis, which leads to an appreciable rate of negativeappendicectomy as reported in world literature varying from 20–40% with its morbidity around 10%.This retrospective study investigated the value of clinical assessment and medical imaging(ultrasonography) for patients with suspected appendicitis. Negative appendicectomy rate andappendiceal perforation with or without medical imaging were used as end points for this investigation.Methods: This study reviewed all patients admitted in Sheikh Khalifa Bin Zaid Hospital withsuspected acute appendicitis. The patient cohort was identified from the unit registry and review ofmedical records. The medical records were analysed, and the outcomes of patients were followed up.Results: Between June 2010 to June 2012, 375 patients’ medical records were audited. These included56.3% males and 43.7% females. The negative appendicitis rate was 7.2% and appendiceal perforationrate was 5.3%. Ultrasound was done in 103 (27.4%) patients in whom diagnosis of appendicitis wasdoubtful. Medical imaging had a 50% prediction rate for acute appendicitis, 40% false-negative rate,and 10% false-positive rate. Overall, the prediction rate for appendicitis by clinical assessmentsupplemented by laboratory tests and medical imaging at clinician’s discretion was 92.8%.Conclusions: Despite studies advocating routine use of medical imaging for patients with suspectedacute appendicitis, this study showed that the clinical evaluation is still paramount to the managementof patients with suspected acute appendicitis before considering medical imaging.Keywords: Acute appendicitis, pain RIF, Clinical assessment, CT scan, UltrasonographyReferences
Liu CD, McFadden DW. Acute abdomen and appendix. In:
Greenfield LJ, et al. (Eds). Surgery: Scientific Principles and
Practice. 2nd edition. Edited by Philadelphia: Lippincott-Raven;
:1246–61.
Sternbach G, Rosen P. Appendicitis: a continuing diagnostic
challenge. J Emerg Med 1995;13:95–6.
Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J,
Gray C. Acute appendicitis: CT and US correlation in 100
patients. Radiology 1994;190:31–5.
Lang EK, Castle E, Trecek J. Computerized tomography
diagnosis of right ureteral calculus and coexisting acute
appendicitis. J Urol 2005;173:2148
Chooi WK, Brown JA, Zetler P, Wiseman S, Cooperberg P.
Imaging of acute appendicitis and its impact on negative
appendectomy and perforation rates: the St. Paul’s experience.
Can Assoc Radiol J 2007;58:220–4.
Guss DA, Behling CA, Munassi D. Impact of abdominal
computed tomography on the rate of negative appendicitis. J
Emerg Med 2008;34:7–11.
in’t Hof KH, van Lankeren W, Krestin GP, Bonjer HJ, Lange JF,
Becking WB, et al. Surgical validation of unenhanced helical
computed tomography in acute appendicitis. Br J Surg
;91:1641–5.
Musunuru S, Chen H, Rikkers LF, Weber SM. Computed
tomography in the diagnosis of acute appendicitis: definitive or
detrimental. J Gastrointest Surg 2007;11:1417–22.
Vadeboncoeur TF, Heister RR, Behling CA, Guss DA. Impact of
helical computed tomography on the rate of negative
appendicitis. Am J Emerg Med 2006;24:43–7.
Lee JH, Jeong YK, Park KB, Park JK, Jeong AK, Hwang JC.
Operator-dependent techniques for graded compression
sonography to detect the appendix and diagnose acute
appendicitis. AJR Am J Roentgenol 2005;184:91–7.
Howell JM, Eddy OL, Lukens TW, Thiessen MEW, Weingart
SD, Decker WW. Clinical policy: critical issues in the evaluation
and management of emergency department patients with
suspected appendicitis. Ann Emerg Med 2010;55:71–116.
Gaitini D, Beck-Razi N, Mor-Yosef D, Fischer D, Ben Itzhak O,
Krausz MM, Engel A. Diagnosing acute appendicitis in adults:
accuracy of color Doppler sonography and MDCT compared
with surgery and clinical follow-up. AJR Am J Roentgenol
;190:1300–6.
Rhea JT, Halpern EF, Ptak T, Lawrason JN, Sacknoff R,
Novelline RA. The status of appendiceal CT in an urban medical
center 5 years after its introduction: experience with 753 patients.
AJR Am J Roentgenol 2005;184:1802–8.
Gauderer MW. Acute abdomen. When to operate immediately
and when to observe. Semin Pediatr Surg 1997;6:74–80.
Kosloske AM, Love CL, Rohrer JE, Goldthorn JF, Lacey SR. The
diagnosis of appendicitis in children: outcomes of a strategy based
on pediatric surgical evaluation. Pediatrics 2004;113:29–34.
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