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Keywords:
Abdomen, Emergency, Ultrasound, Diagnostic procedure, Surgery
Authors:
F. Scutt, M. E. R. Marsden, N. D'Souza, S. Bottomley, N. Nagarajah, A. Higginson, S. Toh; Portsmouth/UK
DOI:
10.1594/ecr2016/C-2373
Conclusion
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 explained by selection bias,
as only the patients that then went on to have an appendicectomy are included in our data.
We are currently analysing all right iliac fossa USS.
USS is a commonly used imaging technique used in the UK as an adjunct in diagnosis for patients with right iliac fossa pain.
Its value compared to other imaging techniques such as CT and MRI are that it does not involve the use of ionising radiation (a particular concern when scanning in the paediatric or pregnant population),
its wide availability and reduced costs compared to CT and MRI.
However in the UK diagnostic accuracy with USS is lower compared to some other countries where it is also used first-line,
such as Holland [4] [5].
This may be due to the fact that in Holland USS for appendicitis is a service provided exclusively by radiologists.
This is consistent with our findings,
which demonstrate that senior radiology clinicians are more likely to identify the appendix (p < 0.001),
and the NAR was also significantly lower (p=0.003) after consultant vs sonographer USS.
From this we may conclude that consultant USS may improve diagnostic accuracy,
reduce NAR and provide safer and more effective patient care.