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Purpose <p>To evaluate the diagnostic agreement between emergency medicine residents after dedicated appendix ultrasound training and radiologists in the ultrasonographic evaluation of suspected acute appendicitis.</p> Methods <p>This prospective, single-center observational study included patients presenting to a tertiary emergency department with non-traumatic abdominal pain and clinical suspicion of acute appendicitis between March 2020 and May 2021. Clinical suspicion was based on right lower quadrant pain or tenderness and supportive clinical, laboratory, or scoring findings. Emergency medicine residents performed focused right lower quadrant ultrasonography after dedicated appendix ultrasound training, followed by radiologist-performed abdominal ultrasonography using the same device. Radiologists were not informed of the resident-performed ultrasound findings. Agreement was assessed using Cohen’s kappa coefficient. Diagnostic accuracy was calculated against the final diagnosis, which was established using pathology, computed tomography when available, surgical consultation, and 30-day follow-up.</p> Results <p>Of 260 enrolled patients, 250 were included in the final analysis. Acute appendicitis was confirmed in 66 patients (26.4%). The appendix was visualized by emergency medicine residents in 77 patients (30.8%) and by radiologists in 94 patients (37.6%; McNemar p = 0.027). Agreement for appendix visualization was moderate (κ = 0.531; 95% CI, 0.417–0.638). Agreement for ultrasonographic diagnosis in the overall cohort was substantial (κ = 0.759; 95% CI, 0.638–0.859) and reached an almost perfect level when both groups visualized the appendix (κ = 0.965; 95% CI, 0.888–1.000). In the overall cohort, resident-performed ultrasonography showed 56.1% sensitivity and 98.9% specificity. In conclusive scans, sensitivity and specificity increased to 94.9% and 94.7%, respectively.</p> Conclusion <p>Resident-performed ultrasonography after dedicated appendix ultrasound training appears highly reliable when the appendix is identified; however, non-diagnostic examinations require further clinical and radiologic assessment.</p> Graphical abstract <p></p>

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Diagnostic agreement between emergency medicine residents after dedicated appendix ultrasound training and radiologists in the ultrasonographic evaluation of suspected acute appendicitis

  • 期刊论文

  • 发表日期：

    2026年8月5日

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  • Senol Ardic,
  • Suna Ibrahimoglu,
  • Eser Bulut,
  • Ozgen Gonenc Cekic,
  • Mustafa Cicek,
  • Recep Dede

摘要

Purpose

To evaluate the diagnostic agreement between emergency medicine residents after dedicated appendix ultrasound training and radiologists in the ultrasonographic evaluation of suspected acute appendicitis.

Methods

This prospective, single-center observational study included patients presenting to a tertiary emergency department with non-traumatic abdominal pain and clinical suspicion of acute appendicitis between March 2020 and May 2021. Clinical suspicion was based on right lower quadrant pain or tenderness and supportive clinical, laboratory, or scoring findings. Emergency medicine residents performed focused right lower quadrant ultrasonography after dedicated appendix ultrasound training, followed by radiologist-performed abdominal ultrasonography using the same device. Radiologists were not informed of the resident-performed ultrasound findings. Agreement was assessed using Cohen’s kappa coefficient. Diagnostic accuracy was calculated against the final diagnosis, which was established using pathology, computed tomography when available, surgical consultation, and 30-day follow-up.

Results

Of 260 enrolled patients, 250 were included in the final analysis. Acute appendicitis was confirmed in 66 patients (26.4%). The appendix was visualized by emergency medicine residents in 77 patients (30.8%) and by radiologists in 94 patients (37.6%; McNemar p = 0.027). Agreement for appendix visualization was moderate (κ = 0.531; 95% CI, 0.417–0.638). Agreement for ultrasonographic diagnosis in the overall cohort was substantial (κ = 0.759; 95% CI, 0.638–0.859) and reached an almost perfect level when both groups visualized the appendix (κ = 0.965; 95% CI, 0.888–1.000). In the overall cohort, resident-performed ultrasonography showed 56.1% sensitivity and 98.9% specificity. In conclusive scans, sensitivity and specificity increased to 94.9% and 94.7%, respectively.

Conclusion

Resident-performed ultrasonography after dedicated appendix ultrasound training appears highly reliable when the appendix is identified; however, non-diagnostic examinations require further clinical and radiologic assessment.

Graphical abstract