ROLE OF ULTRASONOGRAPHY FOR EVALUATION OF ACUTE APPENDICITIS: A UNAMID EXPERIENCE

• Main Authors: Muhammad Tahsin Hashmi, Irum Taqi, Amberin Taqi, Hassan Junaid Sarwar
• Format: Article
• Language: English
• Published: The Army Press 2021-01-01
• Series: Pakistan Armed Forces Medical Journal
• Subjects: appendicitis; sonography; operative; unamid
• Online Access: https://pafmj.org/index.php/PAFMJ/article/view/6214

Objective: To evaluate the accuracy of ultrasound findings as compared to operative findings and positive predictive value of ultrasonography in the diagnosis of acute appendicitis. Study Design: Cross sectional study. Place and Duration of Study: Pak Field Hospital – 7 (Level III) United Nations African Union Mission in Darfur (UNAMID) Darfur, Sudan, from Mar 2015 to Mar 2016. Methodology: All patients presenting with clinically suspected acute appendicitis (Alvarado’s score >4) were referred for right lower quadrant sonography. Three point scale was used to grade sonographic findings ranging from grade 1 to grade 3. Fifty One patients with persistent symptoms and/or positive sonographic findings were operated. Operative findings were also graded on a 3 point scale. Subsequently, sonographic and operative findings were compared. Surgical findings were considered gold standard to assess diagnostic accuracy of sonography. Results: Out of 51 patients 46 (90.2%) were males and 5 (9.8%) were females. Mean age of the patients was 32.3 ± 7.3 years. Among the study subjects, 15 (29.4%) patients were from Nigeria followed by 12 (23.5%) from Pakistan, 7 (13.7%) from Egypt and 17 (33.5%) from other countries. The sonographic findings were detected positive for acute appendicitis in 40 (78.4%) and negative in 11 (21.6%) out of 51. All Fifty-one patients underwent surgery. The surgical findings were positive for appendicitis in 43 patients (84.3%). Four patients with negative sonographic findings did have acute appendicitis according to surgical findings. The positive predictive value was 90.9%. There was good agreement between sonographic findings and surgical findings, which was statistically significant. (κw=0.70 [95% CI, 0.49–0.91]). Conclusion: In our study, sonography has a high PPV and NPV. Sonography should be considered as a primary screening tool in the algorithm of evaluation of acute appendicitis.