Giljaca V, Nadarevic T, Poropat G, et al.   Diagnostic Accuracy of Abdominal Ultrasound for Diagnosis of Acute Appendicitis: Systematic Review and Meta-analysis.
World J Surg. 2016 Nov 18.   (Systematic Review)   PMID: 27864617
Read Abstract Read┬áComments
Clinical Evidence Topic:
Appendicitis
Physician Disciplines Relevance to practice Is this news?
Emergency Medicine
Surgery - General

Print     Share on Facebook   Follow me on Tweeter   Share on Del.icio.us   Share on Reddit   Share on Digg   Share on CiteULike

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.

Comments from Clinical Raters
Emergency Medicine
The standard they used was histopathology as all the studies selected had patients undergoing surgery. It did not include patients with a lower pre-test probability and negative ultrasound who did not go to surgery which is large portion of patients who present.
Emergency Medicine
As an Emergency physician, I find this article puts into perspective that use of ultrasound can not be reliably used to exclude acute appendicitis.
Emergency Medicine
If true, this would be big news in emergency medicine. The practice trend right now is towards much more preferential use of ultrasound over CT in working up appendicitis (esp in children and young women). However, these authors concluded that "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." This is very provocative, if true. I imagine this manuscript will provoke a lot of letters to World J Surgery.
Surgery - General
Clinical assessment continues to win out and it is cheaper.