מתוך medicontext.co.il
WESTPORT, CT (Reuters Health) – When appropriate criteria are applied, ultrasound is more accurate than a surgeon's clinical impression in diagnosing acute appendicitis, according to a report published in the October issue of the Archives of Surgery.
Dr. Kuniyasu Soda, from the Omiya Medical Center in Saitama, Japan, and colleagues studied 89 patients who were admitted to the hospital with suspected appendicitis. A staff surgeon evaluated each patient and determined whether the history and physical examination results were consistent with acute appendicitis or another disease. The patients then underwent ultrasonography.
The ultrasonic probe was applied to the area of maximal tenderness. If a pathologic entity was observed, the examiner placed a finger beneath the probe and palpated the spot to determine pinpoint tenderness. If pinpoint tenderness was confirmed on the appendix or on a diseased region contiguous to the appendix, the patient was diagnosed with acute appendicitis.
The ultrasound protocol described is known as DOPTAUS for Detection Of Pinpoint Tenderness on the Appendix under UltraSound, the investigators note.
Overall, the ultrasound-based protocol was 87.6% accurate in diagnosing acute appendicitis, while the surgeon's initial clinical impression was 70.8% accurate. Furthermore, all 50 patients who had appendiceal pinpoint tenderness on ultrasound had appendicitis confirmed at surgery.
While the current findings are encouraging, the authors emphasize that ultrasonographic examination is no replacement for a surgeon's clinical evaluation. "The combination of clinical judgment and ultrasound can result in a short hospital stay, early surgery, and a low rate of negative laparotomy," they add.
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