A comparison between emergency physicians and radiologists on the interpretation of computed tomography in acute appendicitis: Comparison in Accuracy and Efficiency

Chun-Chieh Chao; Tsung-Hsi  Wang; Hui‐An  Lin; Sheng‐Feng  Lin; Enoch  Kang; Chun‐Chieh  Chao; Peter C.  Hou

doi:10.28982/josam.8013

Authors

Chun-Chieh Chao Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan https://orcid.org/0000-0002-1435-5529
Tsung-Hsi Wang Director of Planning Division, National Health Insurance Administration, Ministry of Health and Welfare, Taiwan https://orcid.org/0000-0003-1948-9849
Hui‐An Lin Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan https://orcid.org/0000-0002-0661-173X
Sheng‐Feng Lin School of Public Health, College of Public Health, Taipei Medical University, Taipei City, Taiwan https://orcid.org/0000-0003-0470-2184
Enoch Kang Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Taiwan https://orcid.org/0000-0002-4903-942X
Chun‐Chieh Chao Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan https://orcid.org/0000-0001-5527-690X
Peter C. Hou Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan https://orcid.org/0000-0002-7726-2901

DOI:

https://doi.org/10.28982/josam.8013

Keywords:

appendicitis, computed tomography, emergency physicians, radiologists

Abstract

Background/Aim: Appendicitis is a common acute abdominal disease seen in the emergency department (ED). Early diagnosis of appendicitis can reduce time to treatment and prevent complications. In this study, we aimed to compare the interpretation of computer tomography (CT) scans between emergency physicians and radiologists.

Methods: We conducted a retrospective cohort study that enrolled patients with CT scans for suspected acute appendicitis in an academic hospital from July 2019 to May 2020. Analysis of the accuracy of the diagnosis of appendicitis and time from completion of CT scan were compared between emergency physicians and radiologists.

Results: A total of 318 patients with appendicitis were included. Patients arriving at the hospital during off-hours were younger (mean difference: 5, P=0.016) and more commonly had normal C-reactive protein (chi-square: 11.19, P<0.001). Neither group’s interpretation of appendicitis was affected by arrival time, and both groups performed differential diagnosis well (emergency physician area under curve [AUC]: 0.912 vs. radiologist AUC: 0.911). Time to CT interpretation by emergency physicians was significantly lower than by radiologists (mean difference: -217.37 min, P<0.001).

Conclusions: The interpretation of abdominal CT scans for acute appendicitis by emergency physicians was more efficient and equally accurate compared to interpretation by radiologists.

Downloads

Download data is not yet available.

References

Stewart BWKP, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S, Vega Rivera F, et al. Global disease burden of conditions requiring emergency surgery. J Br Surg. 2014;101(1):e9-22.

Lowry SF, Davidov T, Shiroff AM. Appendicitis and appendiceal abscess. In: Fischer's Mastery of Surgery. 6th ed. Wolters Kluwer Health Adis (ESP); 2012.

Perez KS, Allen SR. Complicated appendicitis and considerations for interval appendectomy. Jaapa. 2018;31(9):35-41.

Florence M, Flum DR, Jurkovich GJ, Lin P, Steele SR, Symons RG, et al. Negative appendectomy and imaging accuracy in the Washington state surgical care and outcomes assessment program. Ann Surg. 2008;248(4):557-63.

Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB Jr. Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology. 2002;225(1):131-6.

Baird DL, Simillis C, Kontovounisios C, Rasheed S, Tekkis PP. Acute appendicitis. BMJ. 2017;357.

Bhangu A. Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis. Ann Surg. 2014;259(5):894-903.

Dolatabadi AA, Baratloo A, Rouhipour A, Abdalvand A, Hatamabadi H, Forouzanfar M, et al. Interpretation of computed tomography of the head: emergency physicians versus radiologists. Trauma Mon. 2013;18(2):86.

Bagheri-Hariri S, Ayoobi-Yazdi N, Afkar M, Farahmand S, Arbab M, Shahlafar N, et al. Abdominal and pelvic CT scan interpretation of emergency medicine physicians compared with radiologists’ report and its impact on patients’ outcome. Emerg Radiol. 2017;24:675-80.

Chanana L, Jegaraj MA, Kalyaniwala K, Yadav B, Abilash K. Clinical profile of non-traumatic acute abdominal pain presenting to an adult emergency department. J Fam Med Prim Care. 2015;4(3):422-5.

Ho TL, Muo CH, Shen WC, Kao CH. Changing roles of computed tomography in diagnosing acute appendicitis in emergency rooms. QJM. 2015;108(8):625-31.

Kartal ZA, Kozacı N, Çekiç B, Beydilli İ, Akçimen M, Güven DS, et al. CT interpretations in multiply injured patients: comparison of emergency physicians and on-call radiologists. Am J Emerg Med. 2016;34(12):2331-5.

Kang MJ, Sim MS, Shin TG, Jo IJ, Song HG, Song KJ, et al. Evaluating the accuracy of emergency medicine resident interpretations of abdominal CTs in patients with non-traumatic abdominal pain. J Korean Med Sci. 2012;27(10):1255.

Mills AM, Baumann BM, Chen EH, Zhang KY, Glaspey LJ, Hollander JE, et al. The impact of crowding on time until abdominal CT interpretation in emergency department patients with acute abdominal pain. Postgrad Med. 2010;122(1):75-81.