Comparative evaluation of the role of Sonography in diagnosis of Acute Appendicitis versus Surgeon`s clinical impression

Abstract

A randomly selected group of patients presented in Accidents & Emergency department of Jinnah hospital Lahore with complaint of acute lower abdominal pain were subjected to abdominal sonography and those positive for acute appendicitis on ultrasound examination were operated. Another group of randomly selected patients with acute lower abdominal pain in Emergency department were clinically evaluated for acute appendicitis and surgery was done based on clinical impression (history and classical signs for acute appendicitis). Ultrasound examination showed the following parameters. Sensitivity 71.8%, specificity 62.5%, PPV 88.4%, NPV 35.7%. Clinical evaluation showed the sensitivity of 95.2%, specificity 77.7%, PPV 90.9%, NPV 87.5%. It was concluded on the basis of the results that clinical evaluation of the patient is more sensitive in correctly categorizing those who need appendicectomy than the ultrasound examination. Although the latter can be used in suspected cases and to rule out other pathological conditions resulting in acute abdomen. Limitations: Clinical judgment to a large extent rest on the experience and expertise of the surgeon and so is the quality of sonographic results, which depend on experience of sonographer & quality of ultrasound machine.