David Tso MD, Presenter: Nothing to Disclose

Jennifer Wang BS, Abstract Co-Author: Nothing to Disclose

Patrick McLaughlin FFR(RCSI), Abstract Co-Author: Nothing to Disclose

Silvia D. Chang MD, Abstract Co-Author: Nothing to Disclose

Savvas Nicolaou MD, Abstract Co-Author: Nothing to Disclose

This study evaluated the role of operator experience with the use of ultrasound for the work-up of acute appendicitis in young adults. Specifically, we examine resident level of training and compare diagnostic performance with ultrasound technicians and radiology fellows.

A retrospective study design was undertaken examining patients seen in the emergency department of an urban tertiary care teaching hospital between October 1 to December 31, 2013 with the chief complaint of right lower quadrant pain. Patients who were investigated with ultrasound as first-line imaging were identified. Scan time, findings on ultrasound, and need for further imaging was documented along with level of training of the operator performing the exam. Findings were correlated with CT findings and surgical diagnosis when available.

106 patients were identified (80.2% female, mean age 29.1). 39.6% of ultrasound exams were performed between the hours of 5PM and 8AM. Junior (R2 & R3) and senior (R4 & R5) radiology residents scanned 22.6% and 19.8% of the caseload respectively with no statistical difference in scan time (31.6 vs. 26.5 minutes, p=0.43), and did not differ from ultrasound technicians and fellows (28.1 minutes). Further imaging was required in 45.8% of cases performed by junior residents vs. 38.1% by senior residents, although no statistically significant difference was found. Residents as a whole did not differ with technicians/fellows with respects to the need for further imaging (44.4% vs. 31.1%, p=0.17). The appendix was visualized by ultrasound in 37.5% of cases scanned by junior residents, 40.0% of senior resident cases, and 34.0% of cases performed by technicians/fellows with no significant difference found. Sensitivity and specificity for residents as a whole was 50.0% and 90.0%, vs. 81.2% and 100% for technicians/fellows.

This study demonstrates no significant difference with respects to operator experience with the ability to visualize the appendix, scanning time, and requirement of further imaging for the diagnosis of acute appendicitis. There is an increase in sensitivity and specificity when comparing resident trainees and ultrasound technicians/radiology fellows.

This study provides a snapshot of the diagnostic performance of ultrasound for the work-up of acute appendicitis in a tertiary care academic teaching hospital.

Tso, D, Wang, J, McLaughlin, P, Chang, S, Nicolaou, S, Effect of Resident Training Level with Performance of Ultrasound for the Work-up of Acute Appendicitis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045552.html