Investigating Diagnostic Value of Ultrasonography in Acute Appendicitis

Document Type : Original Article

Authors

Department of General Surgery, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Acute appendicitis is one of the most commonly diagnosed surgical diseases that its accurate diagnosis is still a problem, and there is no certainty. Ultrasound is recommended for diagnosis of appendicitis as an easy and noninvasive method. Therefore, due to the spread of disease and the urgent need to accurately diagnose in all educational centers, we decided to determine the diagnostic value of this inclusive method in identifying acute appendicitis. Materials and Methods: This is a descriptive cross-sectional research that was conducted on 540 patients referring to Educational Center of Ayatollah Kashani Hospital. All individuals suspected to appendicitis, and undergone ultrasound was included in the study, and then the result of ultrasound was compared to the obvious pathological results. Data were entered into statistical software of SPSS 20 and were analyzed. Results: According to the ultrasound findings, appendicitis was diagnosed as negative in 351 ones and positive in 189 ones. Ultrasound sensitivity in the diagnosis of appendicitis was 37.1%, while its specificity was 87.2%. The positive predictive value was 96.8% and the negative predictive value was only 11.7%. Conclusion: Considering very low-negative predictive value in educational centers, it is suggested that ultrasound is done for diagnosis of appendicitis only in complicated cases of appendicitis and differential diagnose (kidney stones, and ovarian cysts). In addition, it is recommended that routine ultrasound be avoided for all patients.

Keywords

1.
Mohammadpour A, Basiri MM, Davarinia MQ, Mojtabavi J. Effect of ear acupressure on anxiety and severity of nausea in patients candidate for appendectomy: A Randomized Clinical Trial. Qom Univ Med Sci J 2016;10:1-9.  Back to cited text no. 1
    
2.
Al-Abed YA, Alobaid N, Myint F. Diagnostic markers in acute appendicitis. Am J Surg 2015;209:1043-7.  Back to cited text no. 2
    
3.
Javaherzadeh M, Sabet B, Malekpour AN, Kazeminejad B, Noraee N, Mokhber DM. The predictive value of modified alvarado score in diagnosis of acute appendicitis. Journal of Isfahan Medical School, 2016;34:745-50.  Back to cited text no. 3
    
4.
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. Crit Ultrasound J 2013;5 Suppl 1:S2.  Back to cited text no. 4
    
5.
Hooshmand B, Shokouh-Saremi A, Noferesti A, Yaghoubi MA, Elahifar A. Diagnostic accuracy of Alvarado score in the diagnosis of acute appendicitis. Zahedan J Res Med Sci 2012;13:18-21.  Back to cited text no. 5
    
6.
Hosseini MM, Safdari R, Shahmoradi L, Javaherzadeh M. Better diagnosis of acute appendicitis by using artificial intelligence. ISMJ 2017;20:339-48.  Back to cited text no. 6
    
7.
Amini M, Zandbaf T, Alizadeh SA, Jand Y, Hosseini A, Eshrati B, et al. Alvarado score in the diagnosis of acute appendicitis based on age and sex. Arak Med Univ J 2011;14:12-8.  Back to cited text no. 7
    
8.
Gulzar S, Umar S, Dar GM, Rasheed R. Acute appendicitis – Importance of clinical examination in making a confident diagnosis. Pak J Med Sci 2005;21:125-32.  Back to cited text no. 8
    
9.
Tepel J, Sommerfeld A, Klomp HJ, Kapischke M, Eggert A, Kremer B, et al. Prospective evaluation of diagnostic modalities in suspected acute appendicitis. Langenbecks Arch Surg 2004;389:219-24.  Back to cited text no. 9
    
10.
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: Modern understanding of pathogenesis, diagnosis, and management. Lancet 2015;386:1278-87.  Back to cited text no. 10
    
11.
Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A, et al. Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 2014;133:586-93.  Back to cited text no. 11
    
12.
Farrokh Tehrani D, Layegh P. Evaluation of CT scan in patients suspicious for acute appendicitis with negative or equivocal sonographic findings. Med J Mashhad Univ Med Sci 2015;58:466-72.  Back to cited text no. 12
    
13.
Maa J, Kimberly S, Kirkwood MD. Appendix. In: Sabiston DC, editor. Textbook of Surgery. 18th ed. Philadelphia: Elsevier Saunders; 2008. p. 1335.  Back to cited text no. 13
    
14.
Brunicardi F, Andersen D, Billiar T, Dunn DL, Hunter JG, Matthews JB, Pollock RE. Schwartz's Principles of Surgery. Chapter 30: The Appendix, Authors: Mike K. Liang; Roland E. Andersson; Bernard M. Jaffe; David H. Berger. 10th ed. McGraw-Hill; 2014. 1119-39.  Back to cited text no. 14
    
15.
Farrokh D, Feyzi A, Fallah Rastegar Y. Ultrasound in the differential diagnosis of acute appendicitis. J North Khorasan Univ Med Sci 2016;8:321-30.  Back to cited text no. 15
    
16.
Al-Ajerami Y. Sensitivity and specificity of ultrasound in the diagnosis of acute appendicitis. East Mediterr Health J 2012;18:66-9.  Back to cited text no. 16
    
17.
Ahmai Nejad M, Saki M. Study of sonography sensitivity and specificity to the diagnosis of acute appendicitis in suspected patients referred to Khorramabad Ashayer hospital. Sci Mag Yafte 2012;13:23-7.  Back to cited text no. 17
    
18.
Russo A, Cappabianca S, Iaselli F, Reginelli A, D'Andrea A, Mazzei G, et al. Acute abdominal pain in childhood and adolescence: Assessing the impact of sonography on diagnosis and treatment. J Ultrasound 2013;16:201-7.  Back to cited text no. 18
    
19.
Sezer TO, Gulece B, Zalluhoglu N, Gorgun M, Dogan S. Diagnostic value of ultrasonography in appendicitis. Adv Clin Exp Med 2012;21:633-6.  Back to cited text no. 19
    
20.
Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the modified alvarado scoring system in acute appendicitis. Int J Emerg Med 2012;5:26.  Back to cited text no. 20
    
21.
Kaneko T, Heinz W. Emergency ultrasound in patients with abdominal pain-where should we “look”. Dtsch Med Wochenschr 2015;140:1606-9.  Back to cited text no. 21
    
22.
Fathi M, Hasani SA, Zare MA, Daadpey M, Hojati Firoozabadi N, Lotfi D, et al. Diagnostic accuracy of emergency physician performed graded compression ultrasound study in acute appendicitis: A prospective study. J Ultrasound 2015;18:57-62.  Back to cited text no. 22