Appendicectomy is the most commonly performed emergency surgery procedure in the UK[1].Diagnosis of acute appendicitis often includes established imaging techniques such as ultrasound scan (USS), CT and MRI, which are adjuncts that can improve diagnostic accuracy and reduce negative appendicectomy rate (NAR) when correlated with history and examination findings. NAR in the UK is higher than expected in adeveloped healthcare system at 20.6% [2]; an estimated 8000 of the40,000 appendicectomies carried out annually in the UK are negative [1]. A negative appendicectomy will incur costs...

A retrospective audit looked at all patients undergoing appendicectomy at Queen Alexandra Hospital, a busy 1250 inpatient bed district general hospital in Portsmouth, UK,between 01/10/2013 and 31/03/14. Patients were identified from electronic theatre records, and matched to their histopathology reports and pre-operative USS reports.

260 patients had an appendicectomy. Overall NAR was 27% (69/260). Preoperative diagnostic USS was performed in 38% (98/260) of patients. One USS report was unavailable. Table 1 displays an accuracy analysis of right iliac fossa USS by seniority of ultrasonographer, whilst table 2 displays sonographic identification of appendix pathology.

A recent literature review found that accuracy in the diagnosis of acute appendicitis varies greatly between studies, quoting sensitivities between 44% and 100% and specificities between 47% and 99%.[3] Individual operator skill was highlighted as a possible factor that may contribute to this variation; the more experienced or skilled the operator the greater the diagnostic accuracy of USS. Our results are mostly in line with these findings; however it is noted that the specificities for more senior scanners is lower than expected. This can be...

1. Centre, H.S.C.I., Main Operations Summaries, Hospital Episode Statistics, Admitted Patient Care – England 2006-2012. 2. Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy. Br J Surg, 2013. 100(9): p. 1240-52. 3. Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, et al. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature.Critical Ultrasound Journal 2013;5:Supplement 1:S2. 4. D'Souza, N., et al., The value of ultrasonography in the diagnosis of appendicitis....