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Bedside Ultrasound in the ED Highly Accurate for Acute Appendicitis

ANTALYA, TURKEY – Use of bedside ultrasound in the emergency department has a high rate of accuracy and sensitivity in acute appendicitis, according to a new study.

The technology also had a positive effect on clinical decision making, adds the article in Academic Emergency Medicine.

“Early and accurate diagnosis of acute appendicitis (AA) with ultrasound can minimize the morbidity and mortality of the patients,” write researchers from Antalya Training and Research Hospital in Turkey. “In this regard, ultrasound can help the emergency physicians (EPs) in the diagnosing process and clinical decision making for AA.”

To determine that, researchers used a study sample involving adult patients who presented to the ED with abdominal pain and underwent diagnostic evaluation for AA. All patients were examined initially with point-of-care ultrasound (POCUS) by emergency physicians and then with radiology-performed ultrasound (RADUS) by radiologists.

Pre- and post-POCUS median diagnostic certainty values (MDCVs) for acute appendicitis were determined with visual analogue scale (VAS) scores – 0 not present, 100 certainly present – by clinicians who performed the ultrasounds. Definitive diagnoses were determined by surgery, pathologic evaluation of appendectomy specimens, or clinical follow-up results, and all of the results were compared to determine sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR).

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Of the 264 patients included in the final analysis, 169 (64%) had a diagnosis of AA. The sensitivity, specificity, PLR, and NLR of ultrasound examinations were 92.3%, 95.8%, 21.9, and 0.08, respectively, for POCUS, and 76.9% 97.8%, 36.4, and 0.24, respectively, for RADUS.

Pre-POCUS and post-POCUS VAS scores for MDCVs were 60 and 95, the researchers report.

Previous research has cautioned that, unless well-trained, emergency physicians could have high false-positive rates using ultrasound, but authors of this study disagree.

“POCUS, when performed in the ED for the diagnosis of AA, has high sensitivity and specificity, and had a positive impact on the clinical decision making of the EP,” they conclude.