Document Detail


Prospective evaluation of diagnostic modalities in suspected acute appendicitis.
MedLine Citation:
PMID:  14634825     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The aim of this prospective study was to evaluate different diagnostic modalities routinely employed in a district hospital. METHOD: Four hundred subsequent patients presenting with acute abdominal pain were included over a period of 18 months. Patient characteristics, diagnostic work-up, intraoperative findings, histology and clinical outcome were documented. Rectal temperature, white cell count (WCC), C-reactive protein (CRP), ultrasonography (US) and Ohmann score were analysed with relation to diagnostic value. RESULTS: Negative appendicectomy rate and negative laparotomy rate on the day of admission were 22% and 21%, respectively. Sensitivity was highest for WCC and CRP (0.82 and 0.85) but US showed highest values for specificity (0.92), accuracy (0.85) and odds ratio (13.06). No patient with an Ohmann score below 6.5 suffered from acute appendicitis. With regard to different levels of training in US, experienced surgeons and radiologists had best values for specificity (1.00 and 0.98) and accuracy (0.90 and 0.94). Surprisingly, less-experienced sonographers also achieved good results with regard to specificity (up to 0.96) and positive predictive value (up to 0.89). CONCLUSION: 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.
Authors:
Juergen Tepel; Annette Sommerfeld; Hans-Juergen Klomp; Matthias Kapischke; Albrecht Eggert; Bernd Kremer
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2003-11-22
Journal Detail:
Title:  Langenbeck's archives of surgery / Deutsche Gesellschaft für Chirurgie     Volume:  389     ISSN:  1435-2443     ISO Abbreviation:  Langenbecks Arch Surg     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-06-09     Completed Date:  2004-09-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9808285     Medline TA:  Langenbecks Arch Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  219-24     Citation Subset:  IM    
Affiliation:
Department of General Surgery and Thoracic Surgery, University-Hospital of Schleswig-Holstein, Campus Kiel, Arnold Heller Strasse 7, 24105 Kiel, Germany. jtepel@klinikum.uni-kiel.de
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Appendicitis / diagnosis*,  surgery,  ultrasonography
C-Reactive Protein / analysis
Child
Humans
Leukocyte Count
Logistic Models
Male
Middle Aged
Prospective Studies
Sensitivity and Specificity
Chemical
Reg. No./Substance:
9007-41-4/C-Reactive Protein

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