Original researchThe value of ultrasonography in the diagnosis of appendicitis

- The diagnostic accuracy of ultrasonography is overestimated in the literature.
- The appendix was only visualised in 45% of 573 ultrasound scans across three sites.
- The sensitivity dropped from 81.7% to 51.8% when inconclusive scans were included.

Introduction: Ultrasonography is a commonly used investigation in the UK for patients with right iliac fossa pain where the diagnosis of appendicitis is unclear. The published sensitivity and specificity of ultrasonography is higher than the results observed by clinicians in every day practice. The aim of this study was to elucidate the real-world value of ultrasonography in the diagnosis of appendicitis, and its impact on negative appendicectomy rates (NAR). Methods: A retrospective multicentre audit was conducted at three UK hospitals over a twelve month period in 2012. Results: 573 patients underwent ultrasonography prior to appendicectomy. The appendix was not visualised in 45% of scans. The sensitivity and specificity of ultrasonography for the diagnosis of appendicitis was 51.8% and 81.4%. The mean NAR was 26.7%, or 18.3% after a positive ultrasound scan. Conclusion: In clinical practice at UK centres, ultrasonography commonly does not visualise the appendix, and has a low sensitivity for appendicitis. To reduce the NAR, management options include a return to observation and serial examination, increased use of CT or a commitment to improving the performance of ultrasonography.