Bosphorus Med J. 2023; 10(4): 223-230 | DOI: 10.14744/bmj.2023.72621

Prediagnostic Clinical Evaluations and Double Contrast Computed Tomography in Suspected Acute Appendicitis

Yýlmaz Aydýn¹, Ahmet Doðan Kuday², Verda Tunaligil¹, Derya Abuþka³, Mustafa Yazýcýoðlu⁴, Doðaç Niyazi Özüçelik^5
1Presidency of Emergency Medical Services, Health Directorate of Istanbul, Republic of Turkey Ministry of Health (TR MoH), Istanbul, Türkiye
²Department of Disaster Medicine, Institute of Hamidiye Health Sciences, University of Health Sciences, Istanbul, Türkiye
³Department of Emergency Medicine, TR MoH University of Health Sciences, Istanbul Research and Training Hospital, Istanbul, Türkiye
⁴Department of Emergency Medicine, Yeditepe University, Istanbul, Türkiye
⁵Department of Emergency Medicine, Faculty of Health Sciences, Istanbul University - Cerrahpasa, Istanbul, Türkiye

INTRODUCTION: The aim of this study is to reveal the diagnostic value of abdominal computed tomography (CT) in patients with suspected acute appendicitis according to their histopathological diagnosis and who were operated on after double contrast abdominal CT.
METHODS: The data of patients who were admitted to Bakirkoy Dr. Sadi Konuk Research and Training Hospital Emergency Medicine Clinic between March 01, 2009, and March 01, 2011, due to abdominal pain and were operated on with a clinical diagnosis of the acute appendicitis have been reviewed. The case group consisted of 111 patients who underwent preoperative double-contrast abdominal CT scans; the control group consisted of 50 randomly selected patients who were operated on without abdominal CT scans.
RESULTS: In this study, 57.1% of patients were male, 42.9% of patients were female, and the mean age of patients was 38.90±16.38 years. There was no significant difference between the groups in terms of gender, age, symptoms, body temperature, abdominal physical examination, white blood cells, complete urinalysis results, or Alvarado score (p>0.05). The diagnostic difference between ultrasonography (USG) and CT was found to be statistically significant in patients who were histopathologically diagnosed with appendicitis compared to those who did not. While the sensitivity of USG was 35.71%, specificity 85.71%, positive predictive value (PPV) 90%, and negative predictive value (NPV) 27.02%, the sensitivity of CT was 60.46%, specificity 92%, PPV 92.85%, and NPV 40.35% was found in the diagnosis of acute appendicitis.
DISCUSSION AND CONCLUSION: CT is one of the essential methods that can be used in the diagnosis of acute appendicitis in the emergency department and it can reduce unnecessary laparotomies. Acute appendicitis can be diagnosed by clinical examination and USG in the emergency department, but the value of CT was higher in patients who could not be diagnosed with acute appendicitis by USG.

Keywords: Abdominal, acute appendicitis, Alvarado score, CT, emergency department, EMS, IV contrast.

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Akut Apandisitte Klinik Deðerlendirme ve Çift Kontrastlý Bilgisayarlý Tomografi ile Ön Taný

Yýlmaz Aydýn¹, Ahmet Doðan Kuday², Verda Tunaligil¹, Derya Abuþka³, Mustafa Yazýcýoðlu⁴, Doðaç Niyazi Özüçelik^5
1Acil Saðlýk Hizmetleri Baþkanlýðý, Ýstanbul Saðlýk Müdürlüðü, Türkiye Cumhuriyeti Saðlýk Bakanlýðý (T.C. SB), Ýstanbul, Türkiye
²Saðlýk Bilimleri Üniversitesi, Hamidiye Saðlýk Bilimleri Enstitüsü, Afet Týbbý Anabilim Dalý, Ýstanbul, Türkiye
³T.C. Saðlýk Bakanlýðý Saðlýk Bilimleri Üniversitesi, Ýstanbul Eðitim ve Araþtýrma Hastanesi, Acil Týp Anabilim Dalý, Ýstanbul, Türkiye
⁴Yeditepe Üniversitesi, Acil Týp Anabilim Dalý, Ýstanbul, Türkiye
⁵Ýstanbul Üniversitesi Saðlýk Bilimleri Fakültesi, Acil Týp Anabilim Dalý - Cerrahpaþa, Ýstanbul, Türkiye

GÝRÝÞ ve AMAÇ: Bu çalýþmanýn amacý, histopatolojik tanýya göre akut apandisit ön tanýsý olan ve çift kontrastlý abdominal bilgisayarlý tomografi (BT) sonrasý opere edilen hastalarda abdominal BT’nin tanýsal deðerini ortaya koymaktýr.
YÖNTEM ve GEREÇLER: Bakýrköy Dr. Sadi Konuk Eðitim ve Araþtýrma Hastanesinde, 01 Mart 2009-01 Mart 2011 tarihleri arasýnda, acil týp polikliniðine karýn aðrýsý þikayetiyle baþvuran ve klinik olarak akut apandisit tanýsý ile ameliyat edilen hastalarýn verileri gözden geçirildi. Olgu grubu, ameliyat öncesi çift kontrastlý karýn BT taramasý yapýlan 111 hastadan oluþuyordu; kontrol grubu ise abdominal BT taramasý yapýlmadan opere edilen rastgele seçilmiþ 50 hastadan oluþuyordu.
BULGULAR: Bu çalýþmada hastalarýn %57,1'i erkek, %42,9'u kadýn ve hastalarýn yaþ ortalamasý 38,90±16,38 yýl idi. Gruplar arasýnda cinsiyet, yaþ, semptomlar, vücut ýsýsý, abdominal fizik muayene, beyaz küre, tam idrar tahlili sonuçlarý ve Alvarado skoru açýsýndan anlamlý fark yoktu (p>0,05). Histopatolojik olarak apandisit tanýsý alan hastalarda, almayanlara göre ultrasonografi (USG) ve BT arasýndaki taný farký istatistiksel olarak anlamlý bulundu. Akut apandisit tanýsýnda USG'nin duyarlýlýðý %35,71, özgüllüðü %85,71, pozitif prediktif deðeri (PPV) %90 ve negatif prediktif deðeri (NPV) %27,02 iken, BT’nin duyarlýlýðý %60,46, özgüllüðü %92, PPV deðeri %92,85 ve NPV deðeri %40,35 bulundu.
TARTIÞMA ve SONUÇ: BT, acil serviste akut apandisit tanýsýnda kullanýlabilecek temel yöntemlerden biridir ve gereksiz laparotomiyi azaltabilir. Acil serviste klinik muayene ve USG ile akut apandisit tanýsý konulabilmektedir, ancak USG ile akut apandisit tanýsý konulamayan hastalarda BT deðeri daha yüksek bulunmuþtur.

Anahtar Kelimeler: Acil týp kliniði, ASH, abdominal, akut apandisit, Alvarado skoru, bilgisayarlý tomografi, intravenöz kontrast.

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