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Sensitivity and specificity of ultrasonography in the detection of acute appendicitis

Sensitivity and specificity of ultrasonography in the detection of acute appendicitis
Number of patients Sensitivity Specificity PPV NPV Study Author Year Notes
70 94 89 89 94 [1] Vignault F, et al 1990  
857 90 98 94 97 [2] Schwerk WB, et al 1990  
462 77 NE >92 NE [3] Bendeck SE, et al 2002  
283 86 95 91 92 [4] Kaiser S, et al 2002  
49 84 96 90 NE [5] Sun SS, et al 2002
  • Age >50 years old
40 87 90 NE NE [6] Chang CC, et al 2003  
199 79 78 87 65 [7] Poortman P, et al 2003  
174 100 37 50 100 [8] Rettenbacher T, et al 2003  
125 83 95 NE NE [9] Kessler N, et al 2004  
174 83 95 86 94 [10] Chan I, et al 2005  
MA 88 94 NE NE [11] Doria AS, et al 2006
  • Meta-analysis in children, 26 studies, 9356 patients
MA 83 93 NE NE [11] Doria AS, et al 2006
  • Meta-analysis in adults, 31 studies, 4341 patients
MA 87 89 NE NE [12] Klein MD 2007
  • Meta-analysis, nine studies
420 74 97 88 93 [13] Gaitini D, et al 2008  
132 65 90 84 76 [14] Fox JC, et al 2008  
33 50 100 100 66 [15] Israel GM, et al 2008
  • Pregnant women
121 90 93 NE NE [16] Je BK, et al 2009
  • Criterion is the maximal-outer-diameter >0.57 mm
121 85 96 NE NE [16] Je BK, et al 2009
  • Criterion is the maximal-mural-thickness >0.22 mm
162 87 46 49 85 [17] Schuh S, et al 2010
  • Pediatric patients
193 81 88 61 95 [18] Pacharn P, et al 2010  
204 99 95 NE NE [19] Goldin AB, et al 2011
  • Pediatric patients
147 38 97 NE NE [20] Abo A, et al 2011
  • Pediatric patients
230 77 94 NE NE [21] Leeuwenburgh MM, et al 2013  
965*/469 73*/98 97*/92 NE NE [22] Mittal MK, et al 2013
  • Pediatric patients
150Δ/50◊ 60§/63¥ 94§/99¥ NE NE [22] Mittal MK, et al 2013
  • Pediatric patients
230 48 93 68 84 [23] Leeuwenburgh MM, et al 2014
  • Results of ultrasound imaging with conditional CT
  • Data indicating the role of US use to discriminate simple from perforated appendicitis
97 44 85 70 66 [24] Fathi M, et al 2014
  • Emergency clinicians
85 85 93 NE NE [25] Sivitz AB, et al 2014
  • Pediatric emergency clinicians
  • Pediatric population
81 90‡/87† 86‡/100† 79‡/100† 94‡/93† [26] Orth RC, et al 2014
  • Pediatric patients
97 68 98 NE NE [27] Mallin M, et al 2015
  • Bedside US performed in the emergency department by trained residents with attending supervision and reviewed by a blinded US fellowship-trained clinician
PPV: positive predictive value; NPV: negative predictive value; NE: not evaluable; MA: meta-analysis; CT: computed tomography; US: ultrasound.
* Overall results in 10 centers.
¶ Cases in which the appendix has been clearly visualized on ultrasound.
Δ Enrolled patients (with suspected appendicitis).
◊ Point of care ultrasound.
§ Radiology ultrasound.
¥ Pediatric patients.
‡ When equivocal interpretations were designated positive.
† When equivocal interpretations were designated negative.
References:
  1. Vignault F, Filiatrault D, Brandt ML, Garel L, Grignon A, Ouimet A. Acute appendicitis in children: evaluation with US. Radiology 1990; 176:501.
  2. Schwerk WB, Wichtrup B, Ruschoff J, Rothmund M. Acute and perforated appendicitis: current experience with ultrasound-aided diagnosis. World J Surg 1990; 14:271.
  3. Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB, Jr. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 2002; 225:131.
  4. Kaiser S, Frenckner B, Jorulf HK. Suspected appendicitis in children: US and CT--a prospective randomized study. Radiology 2002; 223:633.
  5. Sun SS, Wu HS, Wang JJ, Ho ST, Kao A. Comparison between technetium 99m hexamethylpropyleneamine oxide labeled white blood cell abdominal scan and abdominal sonography to detect appendicitis in adult patients with atypical clinical presentation. Abdom Imaging 2002; 27:734.
  6. Chang CC, Tsai CY, Lin CC, Jeng LB, Lee CC, Kao CH. Comparison between technetium-99m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan and abdominal sonography to detect appendicitis in children with an atypical clinical presentation. Hepatogastroenterology 2003; 50:426.
  7. Poortman P, Lohle PN, Schoemaker CM, Oostvogel HJ, Teepen HJ, Zwinderman KA et al. Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study. AJR Am J Roentgenol 2003; 181:1355.
  8. Rettenbacher T, Hollerweger A, Macheiner P, Gritzmann N, Daniaux M, Schwamberger K et al. Ovoid shape of the vermiform appendix: a criterion to exclude acute appendicitis--evaluation with US. Radiology 2003; 226:95.
  9. Kessler N, Cyteval C, Gallix B, Lesnik A, Blayac PM, Pujol J et al. Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings. Radiology 2004; 230:472.
  10. Chan I, Bicknell SG, Graham M. Utility and diagnostic accuracy of sonography in detecting appendicitis in a community hospital. AJR Am J Roentgenol 2005; 184:1809.
  11. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S et al. US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis. Radiology 2006; 241:83.
  12. Klein MD. Clinical approach to a child with abdominal pain who might have appendicitis. Pediatr Radiol 2007; 37:11.
  13. Gaitini D, Beck-Razi N, Mor-Yosef D, Fischer D, Ben Itzhak O, Krausz MM, Engel A. Diagnosing acute appendicitis in adults: accuracy of color Doppler sonography and MDCT compared with surgery and clinical follow-up. AJR Am J Roentgenol. 2008; 190:1300.
  14. Fox JC, Solley M, Anderson CL, Zlidenny A, Lahham S, Maasumi K. Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur J Emerg Med. 2008; 15:80.
  15. Israel GM, Malguria N, McCarthy S, Copel J, Weinreb J. MRI vs. ultrasound for suspected appendicitis during pregnancy. J Magn Reson Imaging. 2008; 28:428.
  16. Je BK, Kim SB, Lee SH, Lee KY, Cha SH. Diagnostic value of maximal-outer-diameter and maximal-mural-thickness in use of ultrasound for acute appendicitis in children. World J Gastroenterol. 2009; 15:2900.
  17. Schuh S, Man C, Cheng A, Murphy A, Mohanta A, Moineddin R, Tomlinson G, Langer JC, Doria AS. Predictors of non-diagnostic ultrasound scanning in children with suspected appendicitis. J Pediatr. 2011; 158:112.
  18. Pacharn P, Ying J, Linam LE, Brody AS, Babcock DS. Sonography in the evaluation of acute appendicitis: are negative sonographic findings good enough? J Ultrasound Med. 2010; 29:1749.
  19. Goldin AB, Khanna P, Thapa M, McBroom JA, Garrison MM, Parisi MT. Revised ultrasound criteria for appendicitis in children improve diagnostic accuracy. Pediatr Radiol. 2011; 41:993.
  20. Abo A, Shannon M, Taylor G, Bachur R. The influence of body mass index on the accuracy of ultrasound and computed tomography in diagnosing appendicitis in children. Pediatr Emerg Care. 2011; 27:731.
  21. Leeuwenburgh MM, Wiarda BM, Wiezer MJ, et al. Comparison of imaging strategies with conditional contrast-enhanced CT and unenhanced MR imaging in patients suspected of having appendicitis: a multicenter diagnostic performance study. Radiology 2013; 268:135.
  22. Mittal MK, Dayan PS, Macias CG, et al. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Acad Emerg Med 2013; 20:697.
  23. Leeuwenburgh MM, Wiezer MJ, Wiarda BM, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. Br J Surg 2014; 101:e147.
  24. Fathi M, Hasani SA, Zare MA, et al. Diagnostic accuracy of emergency physician performed graded compression ultrasound study in acute appendicitis: a prospective study. J Ultrasound 2014; 18:57.
  25. Sivitz AB, Cohen SG, Tejani C. Evaluation of acute appendicitis by pediatric emergency physician sonography. Ann Emerg Med 2014; 64:358.
  26. Orth RC, Guillerman RP, Zhang W, et al. Prospective comparison of MR imaging and US for the diagnosis of pediatric appendicitis. Radiology 2014; 272:233.
  27. Mallin M, Craven P, Ockerse P, et al. Diagnosis of appendicitis by bedside ultrasound in the ED. Am J Emerg Med 2015; 33:430.
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