The accuracy of emergency medicine and surgical residents in the diagnosis of acute appendicitis

• Published in: The American journal of emergency medicine 2010-09, Vol.28 (7), p.766-770
• Main Authors: Jo, You Hwan, MD, Kim, Kyuseok, MD, PhD, Rhee, Joong Eui, MD, Kim, Tae Yun, MD, Lee, Jin Hee, MD, Kang, Sung-Bum, MD, Kim, Duck-Woo, MD, Kim, Young Hoon, MD, Lee, Kyoung Ho, MD, Kim, So Yeon, MD, Lee, Christopher C., MD, Singer, Adam J., MD
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Pain - etiology; Acute Disease; Adult; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Appendectomy - statistics & numerical data; Appendicitis; Appendicitis - complications; Appendicitis - diagnosis; Appendicitis - epidemiology; Appendicitis - surgery; Biological and medical sciences; Clinical Competence - standards; Computed tomography; Diagnosis, Differential; Diagnostic Errors - statistics & numerical data; Early Diagnosis; Emergency; Emergency and intensive care: techniques, logistics; Emergency medical care; Emergency Medicine - standards; Female; General Surgery - standards; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Internship and Residency - standards; Linear Models; Male; Medical diagnosis; Medical imaging; Medical sciences; Medicine; Pain; Predictive Value of Tests; Prospective Studies; ROC Curve; Severity of Illness Index; Tomography, X-Ray Computed - standards
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2009.03.017

Abstract Objective This study was conducted to compare the diagnostic accuracy for acute appendicitis between emergency medicine residents (EMRs) and surgical residents (SRs). Methods We conducted a prospective cohort study of adult patients with right lower quadrant pain. Each patient was evaluated by an EMR and an SR, and physicians predicted the probability of appendicitis into 4 groups from highest (group 1) to lowest (group 4). The diagnostic accuracies of EMR and SR for the diagnosis of appendicitis were compared by constructing receiver operating characteristics curves. In each case, an Alvarado score was calculated and a computed tomography (CT) scan of the abdomen and pelvis was performed, and their diagnostic accuracies were also compared with the predicted probabilities. Results Of a total 191 patients, 120 underwent surgery, and the negative appendectomy rate was 6.8%. There was a significant correlation between the predicted probabilities of EMR and SR. The areas under the curve for EMR and SR were 0.698 and 0.657, which were not statistically different. The areas under the curve of the Alvarado score and the CT were 0.735 and 0.978, respectively. The diagnostic accuracy of the CT scan was significantly higher than those of the Alvarado score and the resident-predicted probabilities. Conclusion In patients with right lower quadrant abdominal pain who have already been evaluated by EMR, consultation evaluation by SR does not appear to improve clinical diagnostic accuracy, and routine performance of CT before surgical consultation should be considered for these patients.