EN
TÜRKÇE
Poster - 250
The role of training level and diurnal rhythms in ultrasonography accuracy for acute appendicitis in children
Maryam Ghavami Adel, Amin Miri Disfani, Mobina Taghva Nakhjiri, Hojjatollah Raji
Tehran University of Medical science
Backgrounds: Evidence has shown the role of ultrasonography (US) in the diagnosis of acute appendicitis. The present study aimed to assess the accuracy of the US in determining acute appendicitis, considering the experience of operators and diurnal/nocturnal timing of US admission among patients undergoing an appendectomy.
Methods: A retrospective cross-sectional study was conducted at a referral hospital. The medical records of all admitted patients undergoing appendectomy due to acute appendicitis from March 2021 to September 2022 were entered into the study. All patients’ demographic, clinical, and surgical data were gathered from electronic records.
US and pathological results were also categorized into two groups: positive (in favor of appendicitis), and negative (not in favor of appendicitis). Positive surgery reports were also subcategorized into uncomplicated and complicated appendicitis. Finally, following the relationships between surgical, pathological, and US findings, the data were analyzed, and the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were reported.
Results: 326 eligible patients entered the study. Following the accuracy rates, the results revealed a similar consistency rate of US results according to the surgery or pathological findings. Attending physicians (54.5%) had higher sensitivity compared to residents (14.5%) and non-academic physicians (36%), but all groups showed high specificity, 93.5%, 98%, and 95.5% respectively. Night-admitted cases had lower sensitivity (26% vs. 35%) but higher specificity (97% vs. 95.5%) and NPV (91% vs. 87.5%), suggesting more false negatives but fewer false positives during night shifts.
Conclusions: Lower sensitivity of residents in diagnosis shows that they miss many true cases. Sensitivity remains high regardless of the time; however, specificity and NPV are lower at night, suggesting more false positives and slightly better NPV during night shifts. Burnout among health workers may affect their focus and diagnosis patterns.