Diagnostic Performance and Interobserver Variability of Radiologists in CT-Scan Interpretation of Cases Suspected of Acute Appendicitis

Acute appendicitis is one the most common and sometimes life threatening conditions in the Emergency Department referrals. Since suspected cases of acute appendicitis require immediate diagnosis and proper intervention, the computed tomography (CT) scan becomes the most frequently used modality for such conditions. However, due to the nature of emergency wards, gastrointestinal (GI) expert radiologists may not be always available.

The current study aimed at comparing the interobserver variability of GI expert radiologists, general radiologists, and radiology residents in in CT-scan interpretation of cases suspected of acute appendicitis.

Seventy patients suspected of acute appendicitis admitted to the Emergency Department of our university hospital were included in the study. CT-scan with intravenous contrast was performed on patients that their Alvarado score ranged 5 to 8. Decision for surgical or non-surgical management of patients was made by the routine treatment team of hospital and retrospectively, CTscan images of all 70 patients were reported blindly by three groups of radiologists.

Out of the 70 cases, 48 had positive confirmatory pathology for appendicitis (69%) and 22 had negative pathology report (31%). The sensitivity of the reports for radiology residents, general radiologists, and GI expert radiologists was 81.3%, 93.8% and 95.8%, respectively. The specificity of the diagnosis in the three groups was 72.7%, 86.4% and 81.8%, respectively.

The study results showed that although the interpretation was not perfect, radiology residents and general radiologists can provide reports with acceptable sensitivity and specificity in the emergency ward.