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Lietzén E, Salminen P, Rinta-Kiikka I, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Sand J, Mecklin JP, Jartti A, Virtanen J, Ohtonen P, Ånäs N, Grönroos JM. The Accuracy of the Computed Tomography Diagnosis of Acute Appendicitis: Does the Experience of the Radiologist Matter? Scand J Surg 2017; 107:43-47. [DOI: 10.1177/1457496917731189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background and Aims: To assess the accuracy of computed tomography in diagnosing acute appendicitis with a special reference to radiologist experience. Material and Methods: Data were collected prospectively in our randomized controlled trial comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (APPAC trial, NCT01022567). We evaluated 1065 patients who underwent computed tomography for suspected appendicitis. The on-call radiologist preoperatively analyzed these computed tomography images. In this study, the radiologists were divided into experienced (consultants) and inexperienced (residents) ones, and the comparison of interpretations was made between these two radiologist groups. Results: Out of the 1065 patients, 714 had acute appendicitis and 351 had other or no diagnosis on computed tomography. There were 700 true-positive, 327 true-negative, 14 false-positive, and 24 false-negative cases. The sensitivity and the specificity of computed tomography were 96.7% (95% confidence interval, 95.1–97.8) and 95.9% (95% confidence interval, 93.2–97.5), respectively. The rate of false computed tomography diagnosis was 4.2% for experienced consultant radiologists and 2.2% for inexperienced resident radiologists (p = 0.071). Thus, the experience of the radiologist had no effect on the accuracy of computed tomography diagnosis. Conclusion: The accuracy of computed tomography in diagnosing acute appendicitis was high. The experience of the radiologist did not improve the diagnostic accuracy. The results emphasize the role of computed tomography as an accurate modality in daily routine diagnostics for acute appendicitis in all clinical emergency settings.
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Affiliation(s)
- E. Lietzén
- Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - P. Salminen
- Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - I. Rinta-Kiikka
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - H. Paajanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - T. Rautio
- Department of Surgery, Division of Gastroenterology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - P. Nordström
- Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
| | - M. Aarnio
- Department of Surgery, Jyväskylä Central Hospital and University of Eastern Finland, Jyväskylä, Finland
| | - T. Rantanen
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - J. Sand
- Division of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
| | - J.-P. Mecklin
- Department of Surgery, Jyväskylä Central Hospital and University of Eastern Finland, Jyväskylä, Finland
| | - A. Jartti
- Department of Radiology, Oulu University Hospital, Oulu, Finland
| | - J. Virtanen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - P. Ohtonen
- Medical Research Center Oulu, University of Oulu, Oulu, Finland
- Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - N. Ånäs
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - J. M. Grönroos
- Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
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