Elnaz Vahidi - associate professor of emergency medicine at Tehran university of medical sciences
Marzieh Shahbazpar - Tehran university of medical sciences
Javad Seyedhosseini - Tehran university of medical sciences
Hojat Sheykh Motahar Vahedi - Tehran university of medical sciences
Amirhossein Jahanshir - Tehran university of medical sciences

Background and Aim : Background Although the traditional approach to the diagnosis of acuteappendicitis (AA) is using clinical methods, experience has shown that strict reliance on clinica ldata can lead to mismanagement or unnecessary surgery. Objective The objective of this study wasto determine the total agreement of ultrasound (US) results in AA performed by emergencymedicine (EM) versus radiology residents in emergency department.Methods : Patients and methods In this cross-sectional study, 121 patients with AA suspicionunderwent an US exam by both trained EM and radiology residents in emergency department. Thetraining course for EM residents consisted of attending an 8-h-workshop and then practicing anUS exam on real patients within a 2-month period. The gold standards were either histopathologicor follow-up results. Total agreement of the results in both specialties was compared.Results : Results There were 67 men and 54 women, with a mean age of 33.6 ±16.1 years (18.2–88.7 years). Fifty-four (44.6%) patients underwent surgery with the initial diagnosis of AA andthe rest were evaluated by follow-ups. On the basis ofour gold standards, the diagnosis was finallyconfirmed in 46 (38%) cases. There was a high total agreement in AA diagnosis [96% agreement,κ=0.90; 95% confidence interval (CI)=0.81–0.99] between the two groups. The specificity andsensitivity of EM and radiology groups were 99% (95% CI=93–100), 63% (95% CI=48–77), 97%(95% CI=91–100), and 72% (95% CI=57–84), respectively.Conclusion : Conclusion US has a high diagnostic specificity in patients suspected of having AAand EM residents can perform this modality as accurately as radiologists after training in theemergency setting.

acute appendicitis, emergency department, emergency medicine, radiology, ultrasound