Clinical decision-making, ultrasonography, and scores for evaluation of suspected acute appendicitis

Diagnosing acute appendicitis (aA) remains difficult. This study evaluated the utility of ultrasonography (US) compared to clinical decision-making al one and scoring systems to establish the indication for laparotomy in patie nts in whom aA was suspected. The prospectively documented data of 2209 pat ients admitted for suspicion of aA who underwent US by one of 12 surgeons, formed a database in which the diagnostic and procedural performance of cli nical decision-making, US, two scoring systems (Ohmann and Eskelinen scores ), and clinical algorithms taking account of clinical and either US finding s or score results, were retrospectively evaluated. The results of either m odality were correlated with final diagnoses obtained by laparotomy in 696 patients, of whom 540 had aA (prevalence 24.45%) and follow-up data in the remainder. US had the highest specificity (97%, compared to 93% for the Ohm ann and Eskelinen scores and 94% for the clinical evaluation and algorithms ) and lowest overall rate of false-positive findings (negative laparotomy r ate 7.6%), The scores were accurate in refuting the diagnosis of aA but oth erwise not superior to US. The best overall diagnostic and procedural resul ts were obtained with the algorithms that combined the results of either US or the Ohmann score with clinical evaluation, which produced the most favo rable numbers of negative laparotomies, potential perforations, and missed cases of ak US is the diagnostic standard of reference for patients with a possible diagnosis of aA, It yields diagnostic results superior to those of scoring systems and provisional clinical evaluation. However, the benefits of US by ultrasonographically trained surgeons are only fully appreciated within the context of clinical algorithms. The joint evaluation of score re sults and clinical evaluation may deliver information of similar accuracy.