ULTRASOUND DIAGNOSIS OF APPENDICITIS - A MATTER OF EXPERIENCE

A number of studies have shown that ultrasound has an advantage over p hysical examination in the diagnosis of acute appendicitis. Most of th ese studies were conducted by experts in the field of ultrasonography. In this study the influence of experience on the results of the sonog raphy of acute appendicitis were evaluated. All 203 patients admitted to our unit between December 1990 and December 1992 were examined phys ically and sonographically by a team of surgeons consisting of one exp erienced sonographer and six inexperienced surgical trainees. Laparoto my was performed in 136 patients (46%). Appendicitis was demonstrated histologically in 119 cases (39.4%). Initial clinical findings were po sitive in 87 (28.8%). Sonography was positive in 119 patients (39.4%). The 163 patients not operated on demonstrated other pathology on ultr asound in 60 cases (19.9%). The rate of negative laparotomies amounted to 7.2% in our study. Sensitivity and specificity for the sonographic diagnosis were 92% and 95%, respectively. They were only 81% and 80% for physical examination. Overall accuracy was 92% for sonography. Sen sitivity and specificity for the inexperienced surgeons were 87% and 9 3%, respectively while the experienced surgeon reached values of 97% a nd 98%, respectively. The results of both groups are comparable with v alues in the literature, suggesting that ultrasound evaluation of appe ndicitis is no a diagnostic tool limited to a few experienced sonograp hers.