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Assessing the diagnostic sensitivity of CT and Ultrasound in suspected appendicitis
Poster Title: Assessing the diagnostic sensitivity of CT and Ultrasound in suspected appendicitis
Submitted on 30 Oct 2020
Author(s): Cesar Brito Ramirez 1 , Dilrukshi Gunatillake 2
Affiliations: 1 Junior Clinical Fellow in General Surgery. 2 Consultant Radiologist. Queen Elizabeth Hospital – Woolwich . Lewisham and Greenwich NHS Trust
This poster was presented at BIR 2020
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Poster Information
Abstract: Acute appendicitis is the most common surgical emergency and accounts for one-third of the patients presenting to the emergency department with an acute abdomen, requiring approximately 50,000 admissions every year. This was a retrospective audit including all the patients that underwent an appendicectomy between January and June 2019. Pre-operative CT and US imaging reports were correlated with postoperative histopathology reports. Target: 1. Sensitivity for CT should be >90%. 2. US sensitivity value should be >70%, for the paediatric subgroup should be >85%. 3. The positive predictive value (PPV) should be >92%. Results: CT had a sensitivity of 95%. The ultrasound modality had a sensitivity of 53%, for the paediatric subgroup the sensitivity was 72%. CT scans reported by local radiologist had a sensitivity of 95%, CT scans reported by OOH service had a sensitivity of 96%. The PPV across modalities was 100%. Discussion: The target Sensitivity and PPV for CT were meet. The sensitivity of US was below expected; however, the target on the literature is for an interval scan after initial US screening. This is not a routine practice in our hospital. In recent articles, published in the UK and New Zealand, they report US sensitivity as a primary investigation for appendicitis around 50%. Proposed action plan: To present findings in the departmental audit meeting and the discussion of specific cases of radio-pathological discrepancy. In cases of equivocal initial USS, to recommend an interval USS in young patients and female patients of reproductive age.Summary: Assessing the diagnostic sensitivity of CT and Ultrasound in suspected appendicitis.References: 1 Collins, G. B., et al. (2014). The accuracy of pre-appendectomy computed tomography with histopathological correlation: a clinical audit, case discussion and evaluation of the literature. Emergency radiology, 21(6), 589–595. . 2 Hospital Episode Statistics. Admitted Patient Care–England 2018 –2019. Total Procedures and Interventions. 3 National Surgical Research Collaborative. Multicentre observational study of performance variation in provision and outcome of emergency appendicectomy. Br J Surg. 2013;100(9):1240‐1252. doi:10.1002/bjs.9201. 4 Eng, K., et al. (2018). Acute Appendicitis: A Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US. Radiology, 288(3), pp.717-727. 5 Dude JB, et al. (2012) Computed tomography mimics of acute appendicitis: predictors of appendiceal dReport abuse »
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