The accuracy of emergency medicine and surgical residents in the diagnosis of acute appendicitis

Objective: This study was conducted to compare the diagnostic accuracy for acute appendicitis between emergency medicine residents (EMRs) and surgical residents (SRs). Methods: We conducted a prospective cohort study of adult patients with right lower quadrant pain. Each patient was evaluated by an EMR and an SR, and physicians predicted the probability of appendicitis into 4 groups from highest (group 1) to lowest (group 4). The diagnostic accuracies of EMR and SR for the diagnosis of appendicitis were compared by constructing receiver operating characteristics curves. In each case, an Alvarado score was calculated and a computed tomography (CT) scan of the abdomen and pelvis was performed, and their diagnostic accuracies were also compared with the predicted probabilities. Results: Of a total 191 patients, 120 underwent surgery, and the negative appendectomy rate was 6.8%. There was a significant correlation between the predicted probabilities of EMR and SR. The areas under the curve for EMR and SR were 0.698 and 0.657, which were not statistically different. The areas under the curve of the Alvarado score and the CT were 0.735 and 0.978, respectively. The diagnostic accuracy of the CT scan was significantly higher than those of the Alvarado score and the resident-predicted probabilities. Conclusion: In patients with right lower quadrant abdominal pain who have already been evaluated by EMR, consultation evaluation by SR does not appear to improve clinical diagnostic accuracy, and routine performance of CT before surgical consultation should be considered for these patients. (C) 2010 Elsevier Inc. All rights reserved.