Diagnostic Performance of Emergency Physician Gestalt for Predicting Acute Appendicitis in Patients Age 5 to 20 Years

Simon, Laura; Kene, Mamata V.; Warton, E. Margaret; Rauchwerger, Adina S.; Vinson, David R.; Reed, Mary; Chettipally, Uli K.; Mark, Dustin G.; Sax, Dana R.; McLachlan, D. Ian; Cotton, Dale M.; Lin, James S.; Vazquez‐Benitez, Gabriela; Kharbanda, Anupam B.; Kharbanda, Elyse O.; Ballard, Dustin

doi:10.1111/acem.13931

Cited by 15 publications

(9 citation statements)

References 38 publications

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“…The area under the curve of 0.795 seems fair for a new disease with few specific clinical signs. Emergency physician gestalt has been studied in predicting other diseases and performed equally well, with an observed area under the curve of 0.83 for appendicitis in children, 30 0.75 for acute coronary syndrome, 31 0.86 for acute heart failure syndrome, 32 and 0.81 for pulmonary embolism. 33 In summary, in this large prospective cohort study of patients attending the ED for suspected COVID-19, anosmia, emergency physician estimate of high clinical probability, and bilateral B lines on lung ultrasonography increased the likelihood of identifying COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019

Peyrony

Marbeuf-Gueye

Truong

et al. 2020

Annals of Emergency Medicine

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We seek to describe the medical history and clinical findings of patients attending the emergency department (ED) with suspected coronavirus disease 2019 and estimate the diagnostic accuracy of patients' characteristics for predicting COVID-19. Methods:We prospectively enrolled all patients tested for severe acute respiratory syndrome coronavirus 2 by reversetranscriptase polymerase chain reaction in our ED from March 9, 2020, to April 4, 2020. We abstracted medical history, physical examination findings, and the clinical probability of COVID-19 (low, moderate, and high) rated by emergency physicians, depending on their clinical judgment. We assessed diagnostic accuracy of these characteristics for COVID-19 by calculating positive and negative likelihood ratios.Results: We included 391 patients, of whom 225 had positive test results for severe acute respiratory syndrome coronavirus 2. Reverse-transcriptase polymerase chain reaction result was more likely to be negative when the emergency physician thought that clinical probability was low, and more likely to be positive when he or she thought that it was high. Patient-reported anosmia and the presence of bilateral B lines on lung ultrasonography had the highest positive likelihood ratio for the diagnosis of COVID-19 (7.58, 95% confidence interval [CI] 2.36 to 24.36; and 7.09, 95% CI 2.77 to 18.12, respectively). The absence of a high clinical probability determined by the emergency physician and the absence of bilateral B lines on lung ultrasonography had the lowest negative likelihood ratio for the diagnosis of COVID-19 (0.33, 95% CI 0.25 to 0.43; and 0.26, 95% CI 0.15 to 0.45, respectively). Conclusion:Anosmia, emergency physician estimate of high clinical probability, and bilateral B lines on lung ultrasonography increased the likelihood of identifying COVID-19 in patients presenting to the ED.

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Section: Discussionmentioning

confidence: 99%

Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019

Peyrony

Marbeuf-Gueye

Truong

et al. 2020

Annals of Emergency Medicine

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“…There is a growing interest in applying and teaching gestalt in emergency medicine. In many studies, physician gestalt demonstrates good performance in the diagnosis of pulmonary embolism 12–14 and appendicitis 15,16 . However, some studies have shown that physician gestalt is insufficiently accurate or safe to either rule in or rule out acute coronary syndrome 17 .…”

Section: Introductionmentioning

confidence: 99%

“…In many studies, physician gestalt demonstrates good performance in the diagnosis of pulmonary embolism [12][13][14] and appendicitis. 15,16 However, some studies have shown that physician gestalt is insufficiently accurate or safe to either rule in or rule out acute coronary syndrome. 17 Physician gestalt also has been reported to be less accurate when compared with certain prediction tools in assessing shock and mortality in the ED.…”

Section: Introductionmentioning

confidence: 99%

Physician gestalt for emergency department triage: A prospective videotaped study

Cheng

Sung

et al. 2022

Academic Emergency Medicine

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Objective: Appropriate triage in patients presenting to the emergency department (ED) is often challenging. Little is known about the role of physician gestalt in ED triage. We aimed to compare the accuracy of emergency physician gestalt against the currently used computerized triage process. Methods:We conducted a prospective observational study in the ED at an academic medical center. Adult patients aged ≥20 years were included and underwent a standard triage protocol. The patients underwent system-based triage using the computerized software the Taiwan Triage and Acuity Scale. The entire triage process was recorded, and triage data were collected. Five physician raters provided triage levels (physician-based) according to their perceived urgency after reviewing videos. The primary outcome was hospital admission. The secondary outcomes were ED length of stay (EDLOS) and charges.Results: In total, 656 patients were recruited (mean age 52 years, 50% male). The median system-based triage level was 3. By contrast, the median physician-based triage level was 4. The physician raters tended to provide lower triage levels than the system, with an average difference of 1. There was modest concordance between the two triage methods (correlation coefficient 0.30), with a weighted kappa coefficient of 0.18. The area under the receiver operating curve for the system-and physicianbased triage in predicting hospital admission were similar (0.635 vs. 0.631, p = 0.896).Attending physicians appeared to have better performance than residents in predicting admission. The variation explained (R 2 ) in EDLOS and charges were similar between the two triage methods (R 2 = 3% for EDLOS, 7%-9% for charges).Conclusions: Emergency physician gestalt for triage showed similar performance to a computerized system; however, physicians redistributed patients to lower triage levels. Physician gestalt has advantages for identifying low-risk patients. This approach may avoid undue time pressure for health care providers and promote rapid discharge.

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“…According to analysis, the Alvarado system score involve 8 different parameters and that could be useful for evaluating the health of the individual and planning of the treatment approach to improve health condition of patients. 8 For understanding the score the different parameters are applied that vary between 1 and 2. In addition to this, the summation of score is allowing the medical team for treatment modality.…”

Section: Introductionmentioning

confidence: 99%

A prospective comparative study of TZANAKIS score versus ALVARADO score in the effective diagnosis of acute appendicitis

Patel

Dash²,

Mallick³

et al. 2022

PJMS

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: Multiple scoring systems have been addressed to identify those patients who need emergency appendicectomy as the risk of delay could be avoided. Of these, the consideration of both sore related to the Alvarado and Tzanakis is essential for the study to understand the effective diagnose of acute appendicitis. The study aims to compare and evaluate Alvarado and Tzanakis score for diagnosing the acute appendicitis. This study was conducted in the department of General Surgery associated with the M.K.C.G, Medical College and Hospital, Berhampur from August, 2018 to July, 2020. A total of 96 patients were being considered for carrying out a systematic study after carefully verifying a variety of the inclusion and exclusion criteria. To conduct the study in a systematic manner, the doctor has analyzed and given the score of Alvarado and Tzanakis. On the basis of score of these two approaches, the medical team has provided the treatment to these patients. The proper identification of score has helped to select the method of operation and surgery. In addition to this, the comparison of score focusing on the NPV and PPV has also allowed for identifying the sensitivity. The Alvarado and Tzanakis score was found to have sensitivity along with the specificity of 94.44% and 83.33% respectively. However, the PPV and NPV was found to be 98.84% and 50.00% respectively as compared to Alvarado score where sensitivity, specificity, PPV and NPV was found out to be 77.77%, 66.66%, 97.22% and 16.66% respectively. From the study, it has carried out that the Tzanakis scoring system has been addressed a more reliable for analyzing the condition of patients and offering the treatment. Diagnostic. Alvarado score, with the former achieving higher sensitivity and PPV.

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Diagnostic Performance of Emergency Physician Gestalt for Predicting Acute Appendicitis in Patients Age 5 to 20 Years

Cited by 15 publications

References 38 publications

Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019

Accuracy of Emergency Department Clinical Findings for Diagnosis of Coronavirus Disease 2019

Physician gestalt for emergency department triage: A prospective videotaped study

A prospective comparative study of TZANAKIS score versus ALVARADO score in the effective diagnosis of acute appendicitis

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