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Ultrasonic Diagnosis of Appendicitis: Accurate, But of Little Help
In recent years, ultrasound and computed tomography have been promoted as potentially helpful diagnostic aids in evaluating patients with appendicitis. These Australian researchers subjected ultrasonography to a randomized trial that involved 302 patients (age range, 5 to 82) with suspected appendicitis. Patients were randomly assigned either to evaluation according to a clinical scoring system (followed by ultrasound if the score suggested an intermediate probability of appendicitis) or to routine care.
The sensitivity and specificity of ultrasound were 95% and 89%, respectively. Mean time to operation was 7 hours in the ultrasound group, compared with 10 hours in the routine-care group, a significant difference. However, there were no significant differences between the groups in mean hospital stay (53 hours with ultrasound vs. 55 hours with routine care), proportion of patients undergoing nontherapeutic operations (9% vs. 11%), or delay in treatment for perforations (3% vs. 1%).
Comment: The results of this study confirmed the accuracy of ultrasound but failed to demonstrate any real benefit to the patients who underwent the test. This serves as a reminder of the importance of rigorously testing new diagnostic tools.
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Hookman, M.D., P.A. Home Page