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

Jae Hyug Woo, Jong June Jeon, Seung Joon Choi, Jea Yeon Choi, Yeon Sik Jang, Yong Su Lim, Young Sup Shim, Su Joa Ahn, Ji Hoon Park, Sung Soo Lee

Research output: Contribution to journalArticle

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 44 years) 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.

Original languageEnglish
Pages (from-to)2139-2143
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume36
Issue number12
DOIs
StatePublished - 1 Dec 2018

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Appendicitis
Hospital Emergency Service
Tomography
Emergencies
Physicians
Area Under Curve
Young Adult
Confidence Intervals
ROC Curve
Radiologists
Retrospective Studies
Radiation

Keywords

  • Appendicitis
  • Computer assisted
  • ROC curve
  • Tomography
  • X-ray computed

Cite this

Woo, Jae Hyug ; Jeon, Jong June ; Choi, Seung Joon ; Choi, Jea Yeon ; Jang, Yeon Sik ; Lim, Yong Su ; Shim, Young Sup ; Ahn, Su Joa ; Park, Ji Hoon ; Lee, Sung Soo. / Low-dose (2-mSv) computed tomography for suspected appendicitis : Applicability in an emergency department. In: American Journal of Emergency Medicine. 2018 ; Vol. 36, No. 12. pp. 2139-2143.
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title = "Low-dose (2-mSv) computed tomography for suspected appendicitis: Applicability in an emergency department",
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 44 years) 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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Woo, JH, Jeon, JJ, Choi, SJ, Choi, JY, Jang, YS, Lim, YS, Shim, YS, Ahn, SJ, Park, JH & Lee, SS 2018, 'Low-dose (2-mSv) computed tomography for suspected appendicitis: Applicability in an emergency department', American Journal of Emergency Medicine, vol. 36, no. 12, pp. 2139-2143. https://doi.org/10.1016/j.ajem.2018.03.031

Low-dose (2-mSv) computed tomography for suspected appendicitis : Applicability in an emergency department. / Woo, Jae Hyug; Jeon, Jong June; Choi, Seung Joon; Choi, Jea Yeon; Jang, Yeon Sik; Lim, Yong Su; Shim, Young Sup; Ahn, Su Joa; Park, Ji Hoon; Lee, Sung Soo.

In: American Journal of Emergency Medicine, Vol. 36, No. 12, 01.12.2018, p. 2139-2143.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Low-dose (2-mSv) computed tomography for suspected appendicitis

T2 - Applicability in an emergency department

AU - Woo, Jae Hyug

AU - Jeon, Jong June

AU - Choi, Seung Joon

AU - Choi, Jea Yeon

AU - Jang, Yeon Sik

AU - Lim, Yong Su

AU - Shim, Young Sup

AU - Ahn, Su Joa

AU - Park, Ji Hoon

AU - Lee, Sung Soo

PY - 2018/12/1

Y1 - 2018/12/1

N2 - 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 44 years) 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.

AB - 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 44 years) 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.

KW - Appendicitis

KW - Computer assisted

KW - ROC curve

KW - Tomography

KW - X-ray computed

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