Diagnostic Accuracy of Emergency Physician–Performed Ultrasound for Acute Appendicitis in a Remote Location
| Autor: | François Topin, Pierre-Laurent Massoure, Antoine Bertani, Anne-Lise Thierry, Yann Geffroy, Olivier Catrevaux, Paul Menguy, Thibault Barnoux, Jacques Bougère, Jean-Pierre Tourtier |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Diagnostic accuracy Sensitivity and Specificity 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Humans Medicine Prospective Studies Emergency physician Child Aged Ultrasonography Chi-Square Distribution business.industry Ultrasound 030208 emergency & critical care medicine Emergency department Middle Aged Appendicitis medicine.disease Predictive value Appendix Abdominal Pain medicine.anatomical_structure Child Preschool Acute appendicitis Emergency medicine Emergency Medicine Djibouti Female Emergency Service Hospital business |
| Zdroj: | The Journal of Emergency Medicine. 50:859-867 |
| ISSN: | 0736-4679 |
| DOI: | 10.1016/j.jemermed.2015.06.085 |
| Popis: | Background Preoperative imaging for suspected acute appendicitis (AA), such as ultrasonography (US), was shown to improve diagnostic accuracy and patient outcomes. Criteria for diagnosis of AA by US are well established and reliable. In previous studies, US assessments were always performed by skilled radiologist physicians. However, a radiologist and computed tomography scanning equipment are not always available in the community hospitals or remote sites of developing countries. Objective Our aim was to assess a diagnostic pathway using clinical evaluation, routine US performed by an emergency physician, and clinical re-evaluation for patients suspected of having AA. Methods Patients suspected of having AA admitted to the emergency department in a developing country were prospectively enrolled between November 2010 and January 2011. Clinical and US data were studied. A noncompressible appendix with a diameter ≥6 mm was the main US diagnosis criterion. Results Among the 104 included patients, surgery was performed on 28. Of the 25 patients with positive US, 22 actually had AA, matching the surgical report. The remaining 76 patients without US appendicitis criteria underwent clinical follow-up and had medical conditions. Sensitivity of US was 88%, specificity was 96%, positive predictive value was 88%, and negative predictive value was 96%. The likelihood ratios for our US assessment highlight the need for a test with enhanced diagnostic accuracy. Conclusions A diagnostic strategy using clinical evaluations, routine US performed by emergency physicians, and clinical re-evaluation of patients with acute abdominal pain is appropriate to provide positive results for the diagnosis and treatment of appendicitis in remote locations. |
| Databáze: | OpenAIRE |
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