Routine ultrasonography in the diagnosis of acute appendicitis: a valuable tool in daily practice?

Initial clinical examination, laboratory inflammation parameters, and routine ultrasonography (US) were evaluated prospectively in 205 patients admitted for suspected acute appendicitis. The purpose of the study was to compare initial clinical examination and laboratory tests with the accuracy of US obtained in daily practice. All ultrasonographic examinations were performed by residents in radiology and radiologists qualified for routine abdominal US but not specifically trained in the diagnostics of appendicitis. Initial clinical examination had the highest sensitivity, but the specificity was poor. The single laboratory tests were of limited value in predicting appendicitis. The accuracy of US was disappointing, and the reported promising results of previous studies were not confirmed. Sonographers with less experience had a higher sensitivity but a poorer specificity compared with more experienced sonographers, who had a high specificity at the cost of extremely poor sensitivity. Biases, dichotomization problems, and factors influencing the accuracy of US in patients with suspected acute appendicitis are discussed.