Small Turkish study shows emergency docs have room for improvement with abdominal CT

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 - appendicitis

Emergency physicians increasingly turn to intravenous, contrast-enhanced abdominal CT even when they’re quite sure from symptom presentation alone that the patient has acute appendicitis.

How good are these busy, misdiagnosis-averse doctors at recognizing when such imaging is appropriate—and what is the level of “interobserver agreement” with radiologists?

To find out, Onder Limon, MD, and colleagues in the emergency department of the medical center at Izmir University in Turkey looked at 48 consecutive appendicitis cases in calendar year 2014.

Their observations, published in the August edition of the American Journal of Emergency Medicine, led to their concluding that recognition of the CT criteria for acute appendicitis among emergency doctors is “substantial at best,” and the doctors’ ability to recognize the primary criteria for diagnosing the potentially fatal inflammation is good.

However, emergency physicians “have to gain a higher level of expertise to use this invaluable diagnostic tool more efficiently,” they write.

The small but intriguing study involved four emergency physicians at Izmir who had at least five years of ED experience that included preliminarily reading abdominal CT scans.

Diagnostic sensitivity, specificity, positive predictive value, negative predictive value and other values were calculated by way of comparing ED performance with the radiology department’s final reports.

Criteria by criteria, the comparisons showed the ED physicians’ performance ran the gamut from poor to perfect.

Meanwhile, although the sensitivity and negative predictive value levels for the various criteria were generally high, the calculated values among the four ED physicians and the radiologists were “interestingly fair,” the authors write.

“This distinction may be explained by the differences in standpoints regarding acute-appendicitis diagnosis among emergency physicians and radiology specialists,” they add. “Whereas the emergency physician is only concerned about diagnosing the acute disease, the radiologist has to review the images thoroughly, beyond the scope of acute illness.”

The team did not analyze the factors affecting discrepancy and disagreement rates.

For the numbers and clarifiers behind the conclusions, click here.