Acute appendicitis in adults: Diagnostic accuracy of emergency doctors in a university hospital in Hong Kong

OBJECTIVE: The aim of this study was to assess the diagnostic accuracy of ED doctors with variable training levels in detecting acute appendicitis, without access to advanced imaging in admitted patients with acute abdominal pain in a university hospital of Hong Kong. METHODS: A retrospective analysis was performed on data collected from prospectively identified patients presenting to the ED with acute abdominal pain and admitted to either a surgical or emergency medical ward between December 2011 and October 2012. Their ED diagnoses with regard to acute appendicitis status were compared with their final diagnoses on discharge from hospital. The gold standard was a histopathological diagnosis of acute appendicitis. The diagnostic accuracy was compared against that generally achieved by computed tomography (CT) scanning in other studies (93-98%), the best diagnostic test currently available for acute appendicitis. A good diagnostic test should have an overall accuracy rate of at least 95%. RESULTS: A total of 1653 patients were included in the study. The sensitivity, specificity, positive predictive value and negative predictive value of ED physicians' diagnosis of acute appendicitis were 81% (73-87%), 84% (82-86%), 31% (28-34%) and 98% (97-99%), respectively, giving an overall diagnostic accuracy of 84% (82-85%). The overall accuracy for separate female and male cohorts were 79% (76-82%) and 89% (83-91%), respectively. CONCLUSIONS: Diagnostic accuracy of emergency doctors with variable training levels and no access to advanced imaging in a Hong Kong hospital in detecting appendicitis in patients with acute abdominal pain is higher in male patients than in female patients, but lower than that achieved by CT scanning.