Contribution of ethical approach and effective communication to the correct diagnosis of acute appendicitis – a single center experience from a pragmatic perspective

Ş. Tuna

Department of Radiology, Adnan Menderes University, School of Medicine, Aydın, Turkey. drtunasahin@hotmail.com

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• Radiology
• Surgery

OBJECTIVE: In this study, we reviewed the data of patients who presented to the Emergency Department with abdominal pain, underwent ultrasonography (USG) and computed tomography (CT), and were pathologically diagnosed with acute appendicitis and non-appendicitis. We aimed to emphasize the ethical importance of specifying a clinical diagnosis with its effect on radiologically correct diagnosis and patient management method.

PATIENTS AND METHODS: A total of 1047 patients, 971 patients with acute appendicitis due to pathology, and 76 patients with non-acute appendicitis, who applied to the Emergency Department with acute abdominal pain, underwent ultrasound and/or CT of the whole abdomen were evaluated. According to their clinical diagnoses, both patient groups were divided into acute appendicitis (Group I) and other diagnoses (Group II). After the patients were screened retrospectively, pathology and imaging results were compared with clinical diagnoses.

RESULTS: According to their clinical diagnosis, the pathology result of 654 patients in Group I and 317 patients in Group II was acute appendicitis. Appendicitis was diagnosed in 569 patients in Group I and 240 patients in Group II by performing at least one of the radiological imaging methods. In 162 patients, the diagnosis of appendicitis could not be made by imaging.

CONCLUSIONS: Considering the low negative predictive values in USG and CT examinations for the diagnosis of appendicitis is important. An indication of the clinical diagnosis in accordance with deontology and effective communication between the clinician and the radiologist is important for making a rapid and accurate diagnosis by determining the effective imaging method.

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