Prospective evaluation of diagnostic modalities in suspected acute appendicitis

Abstract

Diagnostic accuracy of acute appendicitis remains insufficient, with an unacceptable high rate of unnecessary operations. Only the promotion of routine ultrasonography might contribute to an improvement in the near future.

Diagnostic score in acute appendicitis. Validation of a diagnostic score (Lintula score) for adults with suspected appendicitis

“…Our rate of negative appendicectomy (15%) was well within the range of the performance criteria for the clinical diagnosis of AA suggested by several authors [11][12][13][14][15][16][17]. On the other hand, the rate of perforations (6%) and the rate of wound infections (no cases in patients with simple appendicitis and three cases in the patients with perforation) were relatively low.…”

“…The appendicitis score performed with a similar accuracy as in our validation study in paediatric patients suspected for AA [10]; but in the control group, the surgeons were able to distinguish AA from other conditions with a relatively high accuracy compared to that reported earlier [12][13][14][15]. Thus, no difference between the two groups was obtained.…”

“…Ultrasonography is not associated with ionising radiation and could, thus, be used without any apparent risk for the patients. Studies have shown that diagnostic US improves the diagnostic accuracy of suspected AA [15,24]. Several studies have evaluated the use of US among general surgeons and shown that the technique of diagnostic US is relatively easy to learn, and, thus, may increase the diagnostic accuracy also among physicians with less experience with US.…”

Unexpected findings on laparoscopy for suspected acute appendicitis: a pro for laparoscopic appendectomy as the standard procedure for acute appendicitis

“…Even ultrasound, the diagnostic tool with the highest specificity, positive predictive value, and highest accuracy to correctly diagnose acute appendicitis [20] fails in some cases. It is important to mention that six of the aforementioned nine patients had findings on ultrasound resembling acute appendicitis.…”

“…At the time of surgery, their unexpected findings might also have been overlooked if open surgery had been performed. As has already been published, an important factor for a correct diagnosis of acute appendicitis is the experienced surgeon [20]. This should always be completed by imaging modalities.…”