Department of General Surgery, Fatih Sultan Mehmet Training and Research Hospital, İstanbul-Turkey.
Ulus Travma Acil Cerrahi Derg. 2021 Jan;27(1):43-49. doi: 10.14744/tjtes.2020.13359.
Acute appendicitis (AA) still maintains its prominence among general surgical emergencies, and the risk of developing AA is 8.6% for men and 6.7% for women. The clinical diagnosis of acute appendicitis has a rate of approximately 20% false positive and false-negative. Ultrasound (US) and Computed Tomography (CT) are the imaging methods most utilized in this field. The present study aims to determine the relationship between the evaluation results of the clinician who examined the patient and the radiologist's evaluation in the evaluation of cross-sectional imaging tests for the diagnosis of acute appendicitis.
In this study, the records of 1891 patients who underwent an appendectomy in the General Surgery Clinic of Fatih Sultan Mehmet Training and Research Hospital between January 2010 and 2017 were reviewed retrospectively. From the file of the patients who underwent appendectomy with acute appendicitis and whose appendix was reported as normal in CT results, clinical examination findings of the patient in the emergency department and CT evaluation results of the relevant surgeon (Compatible with acute appendicitis, normal appendix or appendix could not be visualised) were recorded.
Of the 1891 patients, who underwent appendectomy on suspicion of acute appendicitis, 1478 had CT scans for diagnosis and 145 were reported as normal by radiologists. In the evaluations by surgeons of these CT results all reported as normal by radiologists, 105 (%) 72,4) were compatible with acute appendicitis, while 18 (12.4%) were considered normal. In 22 (15.2%) patients, appendix could not be the visualized by surgeons. 70.0% of the cases with Lymphoid hyperplasia - fibrous obliteration pathology result; 73.8% of the cases with acute appendicitis; 75.6% of those with phlegmonousappendicitis and 64.0% of those with gangrenous/perforated appendicitis were diagnosed as appendicitis by CT evaluation performed by a general surgeon.
Diagnostic accuracy rates increase significantly when the CT results are interpreted by the physician performing the clinical evaluation of the patient. The chance of reaching the correct diagnosis will increase with gaining the ability to interpret abdominal cross-sectional imaging techniques during general surgery specialty training.
急性阑尾炎（AA）仍然是普通外科急症中的主要病症之一，男性患急性阑尾炎的风险为 8.6%，女性为 6.7%。急性阑尾炎的临床诊断准确率约为 20%的假阳性和假阴性。超声（US）和计算机断层扫描（CT）是该领域最常用的影像学方法。本研究旨在确定检查患者的临床医生的评估结果与放射科医生对诊断急性阑尾炎的横断面成像检查评估之间的关系。
本研究回顾性分析了 2010 年至 2017 年期间在法提赫苏丹穆罕默德培训与研究医院普外科接受阑尾切除术的 1891 例患者的病历。从接受阑尾切除术并在 CT 结果中报告阑尾正常的急性阑尾炎患者的病历中，记录了患者在急诊科的临床检查结果和相关外科医生的 CT 评估结果（符合急性阑尾炎、正常阑尾或无法观察到阑尾）。
在怀疑急性阑尾炎而行阑尾切除术的 1891 例患者中，有 1478 例行 CT 扫描诊断，有 145 例报告为放射科医生正常。在对所有报告为正常的放射科医生的 CT 结果进行外科医生评估时，105 例（72.4%）与急性阑尾炎相符，而 18 例（12.4%）被认为正常。在 22 例（15.2%）患者中，外科医生无法观察到阑尾。淋巴组织增生-纤维性闭塞病变结果占 70.0%；急性阑尾炎占 73.8%；蜂窝织炎性阑尾炎占 75.6%；坏疽性/穿孔性阑尾炎占 64.0%。普通外科医生进行的 CT 评估诊断为阑尾炎。
当由对患者进行临床评估的医生解释 CT 结果时，诊断准确率显著提高。在普通外科专业培训中获得解读腹部横断面成像技术的能力，将提高获得正确诊断的机会。
