. 2022 Jun;37(6):1385-1391.

doi: 10.1007/s00384-022-04173-z. Epub 2022 May 18.

Accuracy of imaging in discriminating complicated from uncomplicated appendicitis in daily clinical practice

Matthijs D M Bolmers^#¹, Wouter J Bom^#^{2

3}, Jochem C G Scheijmans⁴, Anna A W van Geloven⁵, Marja A Boermeester⁴, Willem A Bemelman⁴, Charles C van Rossem⁶; SNAPSHOT collaborators

Collaborators, Affiliations

Collaborators

SNAPSHOT collaborators:
G J Van Acker, B Akkermans, G J Akkersdijk, G D Algie, J H Allema, C S Andeweg, N Appeldoorn, J G van Baal, C M den Bakker, S A Bartels, C van den Berg, B Boekestijn, F C den Boer, D Boerma, A L van den Boom, M C Boute, S A Bouwense, J Bransen, F A van Brussel, O R Busch, S M de Castro, H A Cense, C Croese, T van Dalen, I Dawson, E van Dessel, R Dettmers, N Dhar, F Y Dohmen, K W van Dongen, P van Duijvendijk, R R Dulfer, B J Dwars, J P Eerenberg, M van der Elst, E van den Ende, L M Fassaert, J T Fikkers, J W Foppen, E J Furnee, F P Garssen, M F Gerhards, H van Goor, R R Gorter, J S de Graaf, L J Graat, J Groot, A C van der Ham, J F Hamming, J T Hamminga, E van der Harst, J Heemskerk, A Heijne, J T Heikens, E Heineman, R Hertogs, E van Heurn, L C van den Hil, A G Hooftwijk, C C Hulsker, D R Hunen, M S Ibelings, J M Klaase, R Klicks, L Knaapen, R T Kortekaas, F Kruyt, S Kwant, S S Lases, T Lettinga, A Loupatty, R A Matthijsen, R C Minnee, B Mirck, L Mitalas, D Moes, A M Moorman, V B Nieuwenhuijs, G A Nieuwenhuizen, P D Nijk, J M Omloo, A G Ottenhof, H W Palamba, D L van der Peet, I T Pereboom, P W Plaisier, A P van der Ploeg, M H Raber, M M Reijen, H Rijna, C Rosman, R M Roumen, R F Scmitz, Aps van der Velden, W H Scheurs, T A Sigterman, H J Smeets, D J Sonnevled, M N Sosef, S F Spoor, L P Stassen, L van Steensel, E Stortelder, J Straatman, H J van Susante, DES de Hoog, C T van Scheltinga, B R Toorenvliet, P C Verbeek, M Verseveld, J H Volders, M R Vriens, P W Vriens, B C Vrouenraets, B J van de Wall, J A Wegdam, E Westerduin, J J Wever, N A Wijfels, B P Wijnhoven, T A Winkel, D C van der Zee, A M Zeillemaker, C Zietse

Affiliations

¹ Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands.
² Department of Surgery, UMC, Location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands. W.j.bom@amsterdamumc.nl.
³ Department of Surgery, Tergooi MC, Hilversum, The Netherlands. W.j.bom@amsterdamumc.nl.
⁴ Department of Surgery, UMC, Location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands.
⁵ Department of Surgery, Tergooi MC, Hilversum, The Netherlands.
⁶ Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.

^# Contributed equally.

PMID: 35583564
PMCID: PMC9167165
DOI: 10.1007/s00384-022-04173-z

Accuracy of imaging in discriminating complicated from uncomplicated appendicitis in daily clinical practice

Matthijs D M Bolmers et al. Int J Colorectal Dis. 2022 Jun.

. 2022 Jun;37(6):1385-1391.

doi: 10.1007/s00384-022-04173-z. Epub 2022 May 18.

Authors

Matthijs D M Bolmers^#¹, Wouter J Bom^#^{2

3}, Jochem C G Scheijmans⁴, Anna A W van Geloven⁵, Marja A Boermeester⁴, Willem A Bemelman⁴, Charles C van Rossem⁶; SNAPSHOT collaborators

Collaborators

SNAPSHOT collaborators:
G J Van Acker, B Akkermans, G J Akkersdijk, G D Algie, J H Allema, C S Andeweg, N Appeldoorn, J G van Baal, C M den Bakker, S A Bartels, C van den Berg, B Boekestijn, F C den Boer, D Boerma, A L van den Boom, M C Boute, S A Bouwense, J Bransen, F A van Brussel, O R Busch, S M de Castro, H A Cense, C Croese, T van Dalen, I Dawson, E van Dessel, R Dettmers, N Dhar, F Y Dohmen, K W van Dongen, P van Duijvendijk, R R Dulfer, B J Dwars, J P Eerenberg, M van der Elst, E van den Ende, L M Fassaert, J T Fikkers, J W Foppen, E J Furnee, F P Garssen, M F Gerhards, H van Goor, R R Gorter, J S de Graaf, L J Graat, J Groot, A C van der Ham, J F Hamming, J T Hamminga, E van der Harst, J Heemskerk, A Heijne, J T Heikens, E Heineman, R Hertogs, E van Heurn, L C van den Hil, A G Hooftwijk, C C Hulsker, D R Hunen, M S Ibelings, J M Klaase, R Klicks, L Knaapen, R T Kortekaas, F Kruyt, S Kwant, S S Lases, T Lettinga, A Loupatty, R A Matthijsen, R C Minnee, B Mirck, L Mitalas, D Moes, A M Moorman, V B Nieuwenhuijs, G A Nieuwenhuizen, P D Nijk, J M Omloo, A G Ottenhof, H W Palamba, D L van der Peet, I T Pereboom, P W Plaisier, A P van der Ploeg, M H Raber, M M Reijen, H Rijna, C Rosman, R M Roumen, R F Scmitz, Aps van der Velden, W H Scheurs, T A Sigterman, H J Smeets, D J Sonnevled, M N Sosef, S F Spoor, L P Stassen, L van Steensel, E Stortelder, J Straatman, H J van Susante, DES de Hoog, C T van Scheltinga, B R Toorenvliet, P C Verbeek, M Verseveld, J H Volders, M R Vriens, P W Vriens, B C Vrouenraets, B J van de Wall, J A Wegdam, E Westerduin, J J Wever, N A Wijfels, B P Wijnhoven, T A Winkel, D C van der Zee, A M Zeillemaker, C Zietse

Affiliations

¹ Department of Surgery, Dijklander Hospital, Hoorn, The Netherlands.
² Department of Surgery, UMC, Location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands. W.j.bom@amsterdamumc.nl.
³ Department of Surgery, Tergooi MC, Hilversum, The Netherlands. W.j.bom@amsterdamumc.nl.
⁴ Department of Surgery, UMC, Location AMC, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, The Netherlands.
⁵ Department of Surgery, Tergooi MC, Hilversum, The Netherlands.
⁶ Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.

^# Contributed equally.

PMID: 35583564
PMCID: PMC9167165
DOI: 10.1007/s00384-022-04173-z

Abstract

Background: Radiologic imaging can accurately diagnose acute appendicitis, but little is known about its discriminatory capacity between complicated and uncomplicated appendicitis.

Objective: This study aims to investigate the accuracy of imaging in discriminating complicated from uncomplicated appendicitis.

Methods: Data was used from the prospective, nationwide, observational SNAPSHOT appendicitis database, including patients with suspected acute appendicitis who were planned for an appendectomy. Usage of ultrasound (US), CT, MRI or a combination was recorded. Radiological reports were used to group for complicated or uncomplicated appendicitis. The reference standard was based on operative and pathological findings. Primary outcomes were sensitivity and specificity in discriminating complicated from uncomplicated appendicitis. Secondary outcomes were diagnostic accuracy results per imaging modality and for the subgroups age, BMI, and sex.

Results: Preoperative imaging was performed in 1964 patients. In 1434 patients (73%), only US was used; in 109 (6%) patients, only CT was used; and 421 (21%) patients underwent US followed by CT or MRI. Overall, imaging workup as practiced, following the national guideline, had a poor sensitivity for complicated appendicitis of only 35%, although specificity was as high as 93%. For US, accuracy for complicated appendicitis was higher in children than in adults; sensitivity 41.2% vs. 26.4% and specificity 94.6% vs. 93.4%, respectively, p = 0.003. For relevant subgroups such as age, sex and BMI, no other differences in the discriminatory performance were found.

Conclusion: A diagnostic workup with stepwise imaging, using a conditional CT or MRI strategy, poorly discriminates between complicated and uncomplicated appendicitis in daily practice.

Keywords: Complicated appendicitis; Diagnostic accuracy; Imaging; Uncomplicated appendicitis.

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Conflict of interest statement

The author declare no competing interests.

Figures

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References

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Accuracy of imaging in discriminating complicated from uncomplicated appendicitis in daily clinical practice

Collaborators

Affiliations

Accuracy of imaging in discriminating complicated from uncomplicated appendicitis in daily clinical practice

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources