• Logo
  • SBMUJournals

The Accuracy of Emergency Physicians in Ultrasonographic Screening of Acute Appendicitis; a Cross Sectional Study

Ebrahim Karimi, Mohammad Aminianfar, Keivan Zarafshani, Arash Safaie




Introduction: Diagnostic values reported for ultrasonographic screening of acute appendicitis vary widely and are dependent on the operator’s skill, patient’s gender, weight, etc. The present study aimed to evaluate the effect of operator skill on the diagnostic accuracy of ultrasonography in detection of appendicitis by comparing the results of ultrasonography done by radiologists and emergency physicians.

Methods: This prospective diagnostic accuracy was carried out on patients suspected to acute appendicitis presenting to EDs of 2 hospitals. After the initial clinical examinations, all the patients underwent ultrasonography for appendicitis by emergency physician and radiologist, respectively. The final diagnosis of appendicitis was based on either pathology report or 48-hour follow-up. Screening performance characteristics of appendix ultrasonography by emergency physician and radiologist were compared using STATA 11.0 software.

Results: 108 patients with the mean age of 23.91 ± 7.46 years were studied (61.1% male). Appendicitis was confirmed for 37 (34.26%) cases. Cohen's kappa coefficient between ultrasonography by the radiologist and emergency physician in diagnosis of acute appendicitis was 0.51 (95% CI: 0.35 – 0.76). Area under the ROC curve of ultrasonography in appendicitis diagnosis was 0.78 (95% CI: 0.69 – 0.86) for emergency physician and 0.88 (95% CI: 0.81 – 0.94) for radiologist (p = 0.052). Sensitivity and specificity of ultrasonography by radiologist and emergency physician in appendicitis diagnosis were 83.87% (95% CI: 67.32 – 93.23), 91.5% (95% CI: 81.89 – 96.52), 72.97% (95% CI: 55.61 – 85.63), and 83.10% (95% CI: 71.94 – 90.59), respectively.

Conclusion: Findings of the present study showed that the diagnostic accuracy of ultrasonography carried out by radiologist (89%) is a little better compared to that of emergency physician (80%) in diagnosis of appendicitis, but none are excellent.  


Appendicitis; ultrasonography; decision support techniques; emergency service, hospital; diagnosis


Humes D, Simpson J. Acute appendicitis. Bmj. 2006;333(7567):530-4.

Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. Journal of Surgical Research. 2012;175(2):185-90.

Kollár D, McCartan D, Bourke M, Cross K, Dowdall J. Predicting acute appendicitis? A comparison of the Alvarado score, the appendicitis inflammatory response score and clinical assessment. World journal of surgery. 2015;39(1):104-9.

Bower RJ, Bell MJ, Ternberg JL. Controversial aspects of appendicitis management in children. Archives of Surgery. 1981;116(7):885-7.

Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect between incidence of nonperforated and perforated appendicitis: implications for pathophysiology and management. Annals of surgery. 2007;245(6):886-92.

Andersson M, Kolodziej B, Andersson R. Structured Management of Patients with Suspected Acute Appendicitis Using a Clinical Score and Selective Imaging (STRAPPSCORE). 2015.

Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Nia KS, Jafari AM, et al. Screening Performance Characteristic of Ultrasonography and Radiography in Detection of Pleural Effusion; a Meta-Analysis. Emergency. 2016;4(1):1.

Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Darafarin A, Esfahani MRA, et al. Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis. Emergency. 2016;4(2):55.

Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, et al. Application of Ultrasonography and Radiography in Detection of Hemothorax: a Systematic Review and Meta-Analysis. EMERGENCY-An Academic Emergency Medicine Journal. 2016;4(3):116-26.

Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Ghanbari MJH, et al. Diagnostic Accuracy of Ultrasonography and Radiography in Detection of Pulmonary Contusion; a Systematic Review and Meta-Analysis. Emergency. 2015;3(4):127.

Ebrahimi A, Yousefifard M, Kazemi HM, Rasouli HR, Asady H, Jafari AM, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos. 2014;13(4):29-40.

Mallin M, Craven P, Ockerse P, Steenblik J, Forbes B, Boehm K, et al. Diagnosis of appendicitis by bedside ultrasound in the ED. The American journal of emergency medicine. 2015;33(3):430-2.

Kaewlai R, Lertlumsakulsub W, Srichareon P. Body mass index, pain score and Alvarado score are useful predictors of appendix visualization at ultrasound in adults. Ultrasound in medicine & biology. 2015;41(6):1605-11.

Pickuth D, Heywang‐Köbrunner SH, Spielmann RP. Suspected acute appendicitis: is ultrasonography or computed tomography the preferred imaging technique? European Journal of Surgery. 2000;166(4):315-9.

Paulson EK, Kalady MF, Pappas TN. Suspected appendicitis. New England Journal of Medicine. 2003;348(3):236-42.

Elikashvili I, Tay ET, Tsung JW. The Effect of Point-of-care Ultrasonography on Emergency Department Length of Stay and Computed Tomography Utilization in Children With Suspected Appendicitis

Efecto de la Ecografía en el Punto de Atención en la Duración de la Estancia en el Servicio de Urgencias y en la Utilización de la Tomografía Computarizada en los Niños con Sospecha de Apendicitis. Academic Emergency Medicine. 2014;21(2):163-70.

Pinto F, Pinto A, Russo A, Coppolino F, Bracale R, Fonio P, et al. Accuracy of ultrasonography in the diagnosis of acute appendicitis in adult patients: review of the literature. Critical Ultrasound Journal. 2013;5(1):1-3.

Yu S-H, Kim C-B, Park JW, Kim MS, Radosevich DM. Ultrasonography in the Diagnosis of Appendicitis: Evaluation by Meta-analysis. Korean Journal of Radiology. 2005;6(4):267-77.

Angelelli G, Moschetta M, Sabato L, Morella M, Scardapane A, Ianora AAS. Value of “protruding lips” sign in malignant bowel obstructions. European journal of radiology. 2011;80(3):681-5.

Lorusso F, Fonio P, Scardapane A, Giganti M, Rubini G, Ferrante A, et al. Gatrointestinal imaging with multidetector CT and MRI. Recenti progressi in medicina. 2012;103(11):493.

Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey Jr RB. Imaging for Suspected Appendicitis: Negative Appendectomy and Perforation Rates 1. Radiology. 2002;225(1):131-6.

Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A, et al. Ultrasonography/MRI Versus CT for Diagnosing Appendicitis. Pediatrics. 2014;133(4):586-93.

Leeuwenburgh MMN, Wiezer MJ, Wiarda BM, Bouma WH, Phoa SSKS, Stockmann HBAC, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. British Journal of Surgery. 2014;101(1):e147-e55.

Nasiri S, Mohebbi F, Sodagari N, Hedayat A. Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis. International journal of emergency medicine. 2012;5(1):1.

DOI: http://dx.doi.org/10.22037/emergency.v5i1.13518

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


  • There are currently no refbacks.