Appendicitis: should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease?

Abstract

Our aim was to investigate whether diagnostic imaging is required if the clinical presentation suggests acute appendicitis with high probability. On the basis of clinical findings, 350 consecutive patients with clinical suspicion of acute appendicitis were prospectively divided into 3 groups as follows: low, intermediate, and high probability of having appendicitis. All patients then underwent diagnostic ultrasonography. The clinical likelihood of appendicitis and the ultrasonographic results were correlated with the definite diagnoses. In the patients with clinically low probability of having appendicitis, appendicitis was present in 10% (11 of 109 patients), and, in those with intermediate probability, appendicitis was present in 24% (23 of 97 patients). Patients with clinically high probability of having appendicitis had appendicitis in 65% (94 of 144 patients), an alternative diagnosis in 18% (26 of 144 patients), and no specific definitive diagnosis in 17% (24 of 144 patients). Ultrasonography diagnosed appendicitis and the differential diagnoses with a sensitivity of 98% and 97%, specificity of 98% and 100%, positive predictive value of 96% and 99%, negative predictive values of 99% and 99%, and accuracy of 98% and 99%, respectively. Even in patients with clinically high probability of acute appendicitis, diagnostic imaging should be performed because it accurately depicts a high percentage of normal appendices and differential diagnoses.