Performance of imaging studies in patients with suspected appendicitis after stratification with adult appendicitis score

Abstract

Background: Diagnostic scoring is used to stratify patients with suspected appendicitis into three groups: high, intermediate, and low probability of appendicitis. The stratification can be used for selective imaging to avoid the harms of radiation without compromising diagnostic accuracy. The aim was to study how stratification by Adult Appendicitis Score affects diagnostic performance of imaging studies.

Methods: Analysis of 822 patients who underwent diagnostic imaging for suspected appendicitis was made. Adult Appendicitis Score was used to stratify patients into groups of high, intermediate, and low probability of appendicitis. Diagnostic performance of computed tomography (CT) and ultrasound (US) was compared between these patient groups.

Results: After scoring, pre-test probability of appendicitis ranged from 9-16% in low probability group to 75-79% in high probability group in patients who underwent US or CT. Post-test probability of appendicitis after positive CT was 99, 91, and 75% in high probability, intermediate probability and low probability groups, respectively, p < 0.001. After positive US the respective probabilities were 95, 91 and 42%, p < 0.001.

Conclusion: Diagnostic imaging has limited value in patients with low probability of appendicitis according to Adult Appendicitis Score.

Keywords: Abdomen, acute; Adult; Appendicitis; Imaging, diagnostic; Multidetector computed tomography; Ultrasonography, diagnostic.

Fig. 1

Diagnostic work-up of suspected acute appendicitis with Adult Appendicitis Score (AAS). MRI was performed instead of CT in pregnant patients

Fig. 2

Pre-test and post-test probability of appendicitis after positive and negative imaging results. Accuracy of imaging was dependent on the pre-test probability of appendicitis. Negative CT was accurate in all patient groups