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A Clinical Audit to Assess the Diagnostic Yield of CT and Ultrasound and the  Role of Inflammatory Markers in Aiding Scan Acceptance and Prioritisation in Suspected Appendicitis
EP34302
Poster Title: A Clinical Audit to Assess the Diagnostic Yield of CT and Ultrasound and the Role of Inflammatory Markers in Aiding Scan Acceptance and Prioritisation in Suspected Appendicitis
Submitted on 29 Oct 2020
Author(s): Tanakal Wongwarawipat, Christopher Sparks, Luke Lintin
Affiliations: Radiology Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust
This poster was presented at BIR Annual Congress 2020
Poster Views: 154
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Poster Information
Abstract: Introduction:
Acute appendicitis is a common surgical emergency. Computed tomography (CT) and ultrasound (US) have demonstrated good diagnostic accuracy in the detection of acute appendicitis and the potential to reduce the negative appendicectomy rate (NAR). Pre-imaging white cell count (WCC) and C-reactive protein (CRP) have also demonstrated high sensitivity in predicting appendicitis and may aid radiologists when deciding which patients to scan, and whom to prioritise.
Aims:
Assess the degree of clinicopathological correlation between the pre-operative CT/US reports and the histopathology outcomes of patients who underwent appendicectomy, comparing these to national (RCR) standards. The relationship between pre-imaging WCC/CRP and acute appendicitis was also investigated.
Methods:
200 adult and paediatric histopathology reports, pre-operative imaging reports, and pre-imaging inflammatory marker results over a period of 6 months were reviewed.
Results:
Diagnostic accuracy of CT and US was above that expected by RCR standards. The NAR for CT (14.86%) remained above the guidance standard (10%), which was partly attributed to surgical teams opting to proceed to theatre despite negative CT result, and was found to be lower than the NAR for clinical diagnosis (23.81%). Raised WCC/CRP was found to have high diagnostic accuracy (sensitivity 98%, PPV 83%).
Conclusion:
The diagnostic yields of CT and US in detecting appendicitis were comparable to the published literature. The NAR for CT remains significantly less than for clinical diagnosis of appendicitis, supporting evidence for imaging when the clinical diagnosis is in doubt. Patients with normal inflammatory markers are unlikely to have appendicitis, which may aid in prioritisation of scanning.
Summary: Acute appendicitis is a common surgical emergency. We assessed the diagnostic accuracy of computed tomography (CT) and ultrasound (US) in the detection of acute appendicitis and the role of pre-imaging white cell count (WCC) and C-reactive protein (CRP) in predicting appendicitis and aiding scan prioritisation.References: [1] Collins G., Bhogal P., Tan A and Amin O, 2018. Assessing the diagnostic sensitivity of CT and Ultrasound in suspected appendicitis. Available from: https://www.rcr.ac.uk/audit/assessing-diagnostic-sensitivity-ct-and-ultrasound-suspected-appendicitis
[2] Royal College of Surgeons of England, 2014. Commissioning guide: Emergency general surgery (acute abdominal pain). Available from: https://www.rcseng.ac.uk/library-and-publications/rcs-publications/docs/emergency-general-guide/
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