Abstract：
OBJECTIVE: Preoperative imaging is now recommended in patients with suspected acute appendicitis (AA) by the World Society of Emergency Surgery. Our aims were (i) to describe our local practice and (ii) to evaluate the efficiency of performing ultrasound (US) and/or computed tomography (CT) by assessing management failure, specificity and sensitivity, and length of stay in the emergency department (ED).
METHODS: This single-center retrospective study included all patients who underwent US or CT for the management of suspected AA. Patients were included if they were admitted to the ED in February or June between 2012 and 2021.
RESULTS: The study included 339 patients. US was performed in 278 patients (82%), of whom 91 also had a second-line CT (31.3%). There was a significant increase in the rate of CT over the inclusion period. Three percent (3%) of the patients had management failure and a higher age and CT or US + CT were significantly associated with the risk of management failure. Length of stay in the ED increased significantly when a second-line CT was performed. The sensitivity and specificity of US were 84.8% and 93.2%, respectively. Sensitivity was significantly different from CT (100%, p = 0.03) but not specificity (87.9%, p = 0.29). Both US and CT results were more likely to be considered for further management if positive. The vast majority of patients with negative or inconclusive results were admitted in surgical wards or underwent a second-line examination.
CONCLUSIONS: If available in the hospital together with CT, US should probably be performed systematically and as a first-line examination in patients with suspected acute appendicitis.
METHODS: This single-center retrospective study included all patients who underwent US or CT for the management of suspected AA. Patients were included if they were admitted to the ED in February or June between 2012 and 2021.
RESULTS: The study included 339 patients. US was performed in 278 patients (82%), of whom 91 also had a second-line CT (31.3%). There was a significant increase in the rate of CT over the inclusion period. Three percent (3%) of the patients had management failure and a higher age and CT or US + CT were significantly associated with the risk of management failure. Length of stay in the ED increased significantly when a second-line CT was performed. The sensitivity and specificity of US were 84.8% and 93.2%, respectively. Sensitivity was significantly different from CT (100%, p = 0.03) but not specificity (87.9%, p = 0.29). Both US and CT results were more likely to be considered for further management if positive. The vast majority of patients with negative or inconclusive results were admitted in surgical wards or underwent a second-line examination.
CONCLUSIONS: If available in the hospital together with CT, US should probably be performed systematically and as a first-line examination in patients with suspected acute appendicitis.
摘要：
目的：现在，世界急诊外科学会建议对疑似急性阑尾炎（AA）的患者进行术前影像学检查。我们的目的是（i）描述我们的当地做法，（ii）通过评估管理失败来评估执行超声（US）和/或计算机断层扫描（CT）的效率，特异性和敏感性，以及在急诊科（ED）的停留时间。
方法：这项单中心回顾性研究包括所有因怀疑AA而接受US或CT治疗的患者。如果患者在2012年至2021年2月或6月入院，则将其包括在内。
结果：该研究包括339名患者。在278例患者（82%）中进行了US检查，其中91人也进行了二线CT（31.3％）。在包合期内，CT率显着增加。3％（3％）的患者有管理失败，年龄和CT或USCT与管理失败的风险显着相关。进行二线CT检查时，在ED中的停留时间显着增加。US的敏感性和特异性分别为84.8%和93.2%,分别。敏感性与CT有显著差异(100%,p=0.03），但不是特异性（87.9%，p=0.29）。如果阳性，US和CT结果更有可能考虑进一步治疗。绝大多数结果为阴性或不确定的患者被送往外科病房或接受了二线检查。
结论：如果在医院与CT一起使用，对于疑似急性阑尾炎的患者，可能应该系统地进行US检查，并作为一线检查。
方法：这项单中心回顾性研究包括所有因怀疑AA而接受US或CT治疗的患者。如果患者在2012年至2021年2月或6月入院，则将其包括在内。
结果：该研究包括339名患者。在278例患者（82%）中进行了US检查，其中91人也进行了二线CT（31.3％）。在包合期内，CT率显着增加。3％（3％）的患者有管理失败，年龄和CT或USCT与管理失败的风险显着相关。进行二线CT检查时，在ED中的停留时间显着增加。US的敏感性和特异性分别为84.8%和93.2%,分别。敏感性与CT有显著差异(100%,p=0.03），但不是特异性（87.9%，p=0.29）。如果阳性，US和CT结果更有可能考虑进一步治疗。绝大多数结果为阴性或不确定的患者被送往外科病房或接受了二线检查。
结论：如果在医院与CT一起使用，对于疑似急性阑尾炎的患者，可能应该系统地进行US检查，并作为一线检查。
