Low-dose (2-mSv) computed tomography for suspected appendicitis: Applicability in an emergency department - 07/08/18

Doi : 10.1016/j.ajem.2018.03.031

Jae-Hyug Woo, MD ^a,^{^{1
Jae-Hyug Woo and Jong June Jeon contributed equally to this work.}}, Jong June Jeon, PhD ^b,^{^{1
Jae-Hyug Woo and Jong June Jeon contributed equally to this work.}}, Seung Joon Choi, MD ^c,^{^⁎} , Jea Yeon Choi, MD ^a, Yeon Sik Jang, MD ^a, Yong Su Lim, MD ^a, Young Sup Shim, MD ^c, Su Joa Ahn, MD ^d, Ji Hoon Park, MD ^e, Sung Soo Lee, MS ^e
^a Department of Emergency and Critical Care Medicine, Gachon University Gil Medical Center, Incheon, South Korea
^b Department of Statistics, University of Seoul, Seoul, South Korea
^c Department of Radiology, Gachon University Gil Medical Center, Incheon, South Korea
^d Department of Radiology, Seoul National University Hospital, Seoul, South Korea
^e Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea

^⁎Corresponding author.

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Abstract

Objectives

To document the level of interobserver agreement and compare the diagnostic performances of emergency physicians and radiologists at interpreting low radiation CT images of acute appendicitis in adolescents and young adults.

Methods

One hundred and seven adolescents and young adult patients (aged 15 to 44years) that underwent 2-mSv low-dose CT for suspected acute appendicitis between June and December in 2013 were enrolled in this retrospective study. Three emergency physicians and three radiologists with different experiences of low-dose CT independently reviewed CT images. These six physicians rated the likelihood of acute appendicitis using a 5-point Likert scale. We calculated interobserver agreement and compared the diagnostic performances between emergency physicians and radiologists. And diagnostic confidence was also assessed using the likelihood of acute appendicitis.

Results

Acute appendicitis was pathologically confirmed in 42 patients (39%); the remaining 65 patients were considered not to have appendicitis. Fleiss' Kappa for reliability of agreement between emergency physicians and radiologists for the diagnosis of acute appendicitis was 0.720 (95% confidence intervals (CI), 0.685–0.726). Pooled areas under the receiver operating characteristics curve (AUC) for a diagnosis of appendicitis were 0.904 and 0.944 for emergency physicians and radiologists, respectively, and these AUC values were not significantly different (95% confidence interval, −0.087, 0.007; p=0.0855).

Conclusion

The emergency physicians and radiologists showed good interobserver agreement and comparable diagnostic performances for appendicitis in adolescents and adults using low-dose CT images. Low-dose CT could be a useful tool for the diagnosis of appendicitis by emergency physicians.

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Keywords : Appendicitis, Tomography, X-ray computed, Computer assisted, ROC curve