Evaluation of the accuracy of physicians’ diagnostic performances in patients with suspected acute appendicitis

Introduction: With a prevalence rate of 7-8 percent, acute appendicitis is one of the most common public surgical emergencies worldwide. Given the complications of this disease because of lack of medical diagnosis and not on-time arrival of patients, this study evaluated the diagnostic performance of physicians (general or specialist) in patients with suspected appendicitis admitted in Imam Reza Hospital of Birjand in 2015’s second half. Methods: In this cross-sectional study, diagnostic and treatment process from the onset of symptoms to hospitalization and surgery of 147 patients with a diagnosis of acute appendicitis undergoing surgery in the second half of 2015 in Imam Reza (AS) hospital in Birjand were evaluated using questionnaires and checklist. After examining the results of the histopathology, confirmed appendicitis cases were analyzed. The data were analyzed using statistical software SPSS 15 and statistical tests of chi-square, Fisher exact test, and Mann-Whitney U test. Results: In the study, the mean age of the 147 patients was 24.45±13.32 years and all the patients were complaining of abdominal pain. The initial pain in 52% of the cases was in the periumbilical area. Moreover, 105 (71.42%) of the patients presented typical symptoms and 42 (28.57%) had untypical symptoms. Appendicitis in 74.8 percent of patients had led to no complications and 21.1% of them were admitted with generalized peritonitis in surgery. Distribution of the people in cases of complicated appendicitis evaluated by clinical examination (N=22) was significantly lower than uncomplicated cases (99 patients) (P<0.001). A statistically significant difference was found between the cases of complicated and uncomplicated appendicitis in terms of testing, imaging, first physician therapist, and clinical treatment (p= 0.033). Although both groups had direct reference in the first place, many cases of complicated appendicitis were discharged with prescription medication and without any advice or warnings. Conclusions: Based on these results, it is necessary to raise awareness about quick lookup. It is also recommended to physicians to observe early signs and symptoms of appendicitis to accurately refer the patients to specialized diagnostic procedures in order to take quick actions and appropriate treatment.