TY - JOUR
T1 - Accuracy of imaging in discriminating complicated from uncomplicated appendicitis in daily clinical practice
AU - Bolmers, Matthijs D. M.
AU - Bom, Wouter J.
AU - Scheijmans, Jochem C. G.
AU - van Geloven, Anna A. W.
AU - Boermeester, Marja. A.
AU - Bemelman, Willem A.
AU - van Rossem, Charles. C.
AU - on behalf of the SNAPSHOT collaborators
AU - van Acker, Gj
AU - Akkermans, B.
AU - Akkersdijk, Gj
AU - Algie, Gd
AU - Allema, Jh
AU - Andeweg, Cs
AU - Appeldoorn, N.
AU - van Baal, Jg
AU - den Bakker, Cm
AU - Bartels, Sa
AU - van den Berg, C.
AU - Boekestijn, B.
AU - den Boer, Fc
AU - Boerma, D.
AU - van den Boom, Al
AU - Boute, Mc
AU - Bouwense, Sa
AU - Bransen, J.
AU - van Brussel, Fa
AU - Busch, Or
AU - de Castro, Sm
AU - Cense, Ha
AU - Croese, C.
AU - van Dalen, T.
AU - Dawson, I.
AU - van Dessel, E.
AU - Dettmers, R.
AU - Dhar, N.
AU - Dohmen, Fy
AU - van Dongen, Kw
AU - Garssen, Fp
AU - Gerhards, Mf
AU - Gorter, Rr
AU - Groot, J.
AU - van der Ham, Ac
AU - van Heurn, E.
AU - Ottenhof, Ag
AU - van der Peet, Dl
AU - Rijna, H.
AU - Straatman, J.
AU - van Susante, Hj
AU - Volders, Jh
AU - Winkel, Ta
AU - van Duijvendijk, P.
AU - Dulfer, Rr
AU - Dwars, Bj
AU - Eerenberg, Jp
AU - van der Elst, M.
AU - van den Ende, E.
AU - Fassaert, Lm
AU - Fikkers, Jt
AU - Foppen, Jw
AU - Mirck, B.
AU - Westerduin, E.
N1 - Publisher Copyright: © 2022, The Author(s).
PY - 2022/6/1
Y1 - 2022/6/1
N2 - 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.
AB - 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.
KW - Complicated appendicitis
KW - Diagnostic accuracy
KW - Imaging
KW - Uncomplicated appendicitis
UR - http://www.scopus.com/inward/record.url?scp=85130327945&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00384-022-04173-z
DO - https://doi.org/10.1007/s00384-022-04173-z
M3 - Article
C2 - 35583564
SN - 0179-1958
VL - 37
SP - 1385
EP - 1391
JO - International journal of colorectal disease
JF - International journal of colorectal disease
IS - 6
ER -