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World Journal of Surgery
Published in: World Journal of Surgery 3/2017

01-03-2017 | Original Scientific Report

Diagnostic Accuracy of Abdominal Ultrasound for Diagnosis of Acute Appendicitis: Systematic Review and Meta-analysis

Authors: Vanja Giljaca, Tin Nadarevic, Goran Poropat, Vesna Stefanac Nadarevic, Davor Stimac

Published in: World Journal of Surgery | Issue 3/2017

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Abstract

Background

To determine the diagnostic accuracy of abdominal ultrasound (US) for the diagnosis of acute appendicitis (AA), in terms of sensitivity, specificity and post-test probabilities for positive and negative result.

Methods

A systematic search of MEDLINE, Embase, The Cochrane library and Science Citation Index Expanded from January 1994 to October 2014 was performed. Two authors independently evaluated studies for inclusion, extracted data and performed analyses. The reference standard for evaluation of final diagnosis was pathohistological report on tissue obtained at appendectomy. Summary sensitivity, specificity and post-test probability of AA after positive and negative result of US with corresponding 95% confidence intervals (CI) were calculated.

Results

Out of 3306 references identified through electronic searches, 17 reports met the inclusion criteria, with 2841 included participants. The summary sensitivity and specificity of US for diagnosis of AA were 69% (95% CI 59–78%) and 81% (95% CI 73–88%), respectively. At the median pretest probability of AA of 76.4%, the post-test probability for a positive and negative result of US was 92% (95% CI 88–95%) and 55% (95% CI 46–63%), respectively.

Conclusions

Abdominal ultrasound does not seem to have a role in the diagnostic pathway for diagnosis of AA in suspected patients. The summary sensitivity and specificity of US do not exceed that of physical examination. Patients that require additional diagnostic workup should be referred to more sensitive and specific diagnostic procedures, such as computed tomography.
Literature
1.
Murata A, Okamoto K, Mayumi T et al (2014) Age-related differences in outcomes and etiologies of acute abdominal pain based on a national administrative database. Tohoku J Exp Med 233:9–15CrossRefPubMed
2.
Gwynn LK (2001) The diagnosis of acute appendicitis: clinical assessment versus computed tomography evaluation. J Emerg Med 21:119–123CrossRefPubMed
3.
Addiss DG, Shaffer N, Fowler BS et al (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925CrossRefPubMed
4.
Lee SL, Walsh AJ, Ho HS (2001) Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg 136:556–562CrossRefPubMed
5.
Golledge J, Toms AP, Franklin IJ et al (1996) Assessment of peritonism in appendicitis. Ann R Coll Surg Engl 78:11–14PubMedPubMedCentral
6.
Abdul Rahman MM, Salh AM, Al-Sand SN (2006) The value of history taking, physical examination in the study of acute appendicitis in comparison to histopathology. Iraqi Postgrad Med J 5:46–53
7.
Izbicki JR, Wolfram TK, Dietmar KW et al (1992) Accurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients. Eur J Surg 158:227–231PubMed
8.
9.
10.
Howell JM, Eddy OL, Lukens TW et al (2010) Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med 55:71–116CrossRefPubMed
11.
Nitta N, Takahashi M, Furukawa A et al (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21:156–165CrossRefPubMed
12.
Al-Ajerami Y (2012) Sensitivity and specificity of ultrasound in the diagnosis of acute appendicitis. East Mediterr Health J 18:66–69PubMed
13.
Nasiri S, Mohebbi F, Sodagari N et al (2012) Diagnostic values of ultrasound and the modified Alvarado scoring system in acute appendicitis. Int J Emerg Med 5:26CrossRefPubMedPubMedCentral
14.
Kim SY, Lee KH, Kim K et al (2011) Acute appendicitis in young adults: low-versus standard-radiation-dose contrast-enhanced abdominal CT for diagnosis. Radiology 260:437–445CrossRefPubMed
15.
Leeuwenburgh MMN, Wiarda BM, Wiezer MJ et al (2013) Comparison of imaging strategies with conditional contrast-enhanced CT and unenhanced MR imaging in patients suspected of having appendicitis: a multicenter diagnostic performance study. Radiology 268:135–143CrossRefPubMed
16.
Moineddin DAS, Kellenberger CJ, Epelman M et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 24:83–94
17.
Wilms IM, de Hoog DE, de Visser DC et al (2011) Appendectomy versus antibiotic treatment for acute appendicitis. Cochrane Database Syst Rev 11:CD008359
18.
Bergeron E (2006) Clinical judgment remains of great value in the diagnosis of acute appendicitis. Can J Surg 49:96–100PubMedPubMedCentral
19.
Flum DR, Morris A, Koepsell T et al (2001) Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 286:1748–1753CrossRefPubMed
20.
Sauerland S, Lefering R, Neugebauer EA (2004) Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 4:CD001546
21.
Guller U, Hervey S, Purves H et al (2004) Laparoscopic versus open appendectomy outcomes comparison based on a large administrative database. Ann Surg 239:43–52CrossRefPubMedPubMedCentral
22.
23.
Vinz H, Neu J (2007) Malpractice claims relating to the diagnosis and treatment of acute appendicitis-decisions of the Norddeutsche Schlichtungsstelle (Expert Panel for Extrajudicial Claims Resolution of the Medical Associations in Northern Germany). Z Arztl Fortbild Qualitatssich 101:553–563PubMed
24.
Whiting PF, Rutjes AWS, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155:529–536CrossRefPubMed
25.
Review Manager (RevMan) [Computer Program] (2012) Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration
26.
Reitsma JB, Glas AS, Rutjes AWS et al (2005) Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol 58:982–990CrossRefPubMed
27.
28.
SAS 9.2 [Computer Program]. SAS E. Version 9.2. Cary, NC, USA: SAS Institute Inc., 2008. Computer Program
29.
Schuetz GM, Schlattmann P, Dewey M et al (2012) Use of 3 × 2 tables with an intention to diagnose approach to assess clinical performance of diagnostic tests: meta-analytical evaluation of coronary CT angiography studies. BMJ 345:e6717CrossRefPubMedPubMedCentral
30.
Bendeck SE, Nino-Murcia M, Berry GJ et al (2002) Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 225:131–136CrossRefPubMed
31.
Fergusson JA, Hitos K, Simpson E (2002) Utility of white cell count and ultrasound in the diagnosis of acute appendicitis. ANZ J Surg 72:781–785CrossRefPubMed
32.
Flum DR, McClure TD, Morris A et al (2005) Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg 201:933–939CrossRefPubMed
33.
Gökçe AH, Aren A, Gökçe FS et al (2011) Reliability of ultrasonography for diagnosing acute appendicitis. Ulus Travma Acil Cerrahi Derg 17:19–22CrossRefPubMed
34.
Grodziński T, Gackowski W, Nyckowski P (2004) Ultrasonography in the diagnosis of acute appendicitis. Pol Przegl Chir 76:1165–1174
35.
John SK, Joseph J, Shetty SR (2011) Avoiding negative appendectomies in rural surgical practice: is C-reactive protein estimation useful as a diagnostic tool? Natl Med J India 24:144–147PubMed
36.
Khanzada TW, Samad A, Sushel C (2009) Negative Appendectomy Rate: Can It Be Reduced? J Liaquat Uni Med Health Sci 8:19–22
37.
Köksal H, Uysal B, Sarıbabıççı R (2009) The role of the Alvarado scoring system and ultrasonography in the diagnosis of acute appendicitis. Gazi Med. J. 20:113–116
38.
Kurane SB, Sangolli MS, Gogate AS (2008) A one year prospective study to compare and evaluate diagnostic accuracy of modified Alvarado score and ultrasonography in acute appendicitis, in adults. Indian J Surg 70:125–129CrossRefPubMedPubMedCentral
39.
Memisoglu K, Karip B, Mestan M et al (2010) The value of preoperative diagnostic tests in acute appendicitis, retrospective analysis of 196 patients. World J Emerg Surg 5:5CrossRefPubMedPubMedCentral
40.
Peixoto Rde O, Nunes TA, Gomes CA (2011) Indices of diagnostic abdominal ultrasonography in acute appendicitis: influence of gender and physical constitution, time evolution of the disease and experience of radiologist. Rev Col Bras Cir 38:105–111CrossRefPubMed
41.
Saeed K, Mehboob F, Azam V (2009) Role of abdominal sonography in the diagnosis of acute appendicitis. Rawal Med J 34:138–140
42.
Sezer TO, Gulece B, Zalluhoglu N et al (2012) Diagnostic value of ultrasonography in appendicitis. Adv Clin Exp Med 21:633–636PubMed
43.
Sharma R, Kasliwal DK, Sharma RG (2007) Evaluation of negative appendicectomy rate in cases of suspected acute appendicitis and to study the usefulness of ultrasonography in improving the diagnostic accuracy. Indian J Surg 69:194–197CrossRefPubMed
44.
Stunell H, Aremu M, Collins D et al (2008) Assessment of the value of pelvic ultrasonography in pre-menopausal women with right iliac fossa pain. Ir Med J 101:216–217PubMed
45.
Uebel P, Weiss H, Trimborn CP et al (1996) Ultrasound diagnosis of acute appendicitis—possibilities and limits of the method—results of prospective and retrospective clinical studies. Ultraschall Med 17:100–105CrossRefPubMed
46.
West WM, Brady-West DC, McDonald AH et al (2006) Ultrasound and white blood cell counts in suspected acute appendicitis. West Indian Med J 55:100–102CrossRefPubMed
47.
Mallin M, Craven P, Ockerse P et al (2015) Diagnosis of appendicitis by bedside ultrasound in the ED. Am J Emerg Med 33:430–432CrossRefPubMed
48.
Hussain S, Rahman A, Abbasi T et al (2014) Diagnostic accuracy of ultrasonography in acute appendicitis. J Ayub Med Coll Abbottabad 26:12–17PubMed
49.
Nielsen JW, Boomer L, Kurtovic K et al (2015) Reducing computed tomography scans for appendicitis by introduction of a standardized and validated ultrasonography report template. J Pediatr Surg 50:144–148CrossRefPubMed
50.
Shogilev D, Duus N, Odom SR et al (2014) Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med 15:859–871CrossRefPubMedPubMedCentral
51.
Buscemi N, Hartling L, Vandermeer B (2006) Single data extraction generated more errors than double data extraction in systematic reviews. J Clin Epidemiol 59:697–703CrossRefPubMed
52.
Orr RK, Porter D, Hartman D (1995) Ultrasonography to evaluate adults for appendicitis: decision making based on meta-analysis and probabilistic reasoning. Acad Emerg Med 2:644–650CrossRefPubMed
53.
Terasawa T, Blackmore CC, Bent S et al (2004) Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 141:537–546CrossRefPubMed
54.
Weston AR, Jackson TJ, Blamey S (2005) Diagnosis of appendicitis in adults by ultrasonography or computed tomography: a systematic review and meta-analysis. Int J Technol Assess Health Care 21:368–379CrossRefPubMed
55.
56.
Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94CrossRefPubMed
57.
Al-Khayal KA, Al-Omran MA (2007) Computed tomography and ultrasonography in the diagnosis of equivocal acute appendicitis. Saudi Med J 28:173–180PubMed
58.
van Randen A, Bipat S, Zwinderman AH et al (2008) Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 249:97–106CrossRefPubMed
59.
Carroll PJ, Gibson D, El-Faedy O et al (2013) Surgeon-performed ultrasound at the bedside for the detection of appendicitis and gallstones: systematic review and meta-analysis. Am J Surg 205:102–108CrossRefPubMed
Metadata
Title
Diagnostic Accuracy of Abdominal Ultrasound for Diagnosis of Acute Appendicitis: Systematic Review and Meta-analysis
Authors
Vanja Giljaca
Tin Nadarevic
Goran Poropat
Vesna Stefanac Nadarevic
Davor Stimac
Publication date
01-03-2017
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 3/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3792-7

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