Abstract

Background: Acute appendicitis poses diagnostic challenges in emergency department (ED) settings, warranting efficient diagnostic approaches. Methods: We conducted a prospective study involving 258 adult patients presenting with suspected acute appendicitis. Patients underwent ultrasound examinations performed by trained ED physicians following a pragmatic imaging protocol emphasizing graded compression and visualization of the appendix and surrounding structures. Clinical and ultrasound findings were correlated with surgical outcomes to determine diagnostic accuracy. Results: Ultrasound accurately diagnosed acute appendicitis in 210 out of 258 cases, yielding a sensitivity of 81% and specificity of 92%. Subgroup analysis showed higher accuracy in patients aged 18-40 years (sensitivity 85%, specificity 94%) compared to those over 40 years (sensitivity 75%, specificity 88%). Ultrasound identified alternative diagnoses in 20% of cases initially suspected as appendicitis. Comparison with CT scans showed comparable diagnostic accuracy but with lower radiation exposure and cost. Conclusion: This study supports the pragmatic use of ultrasound in the ED for suspected acute appendicitis, demonstrating high diagnostic accuracy, especially in younger adults, and significant potential for reducing unnecessary surgeries and healthcare costs. It is concluded that ultrasound, as part of a pragmatic approach in the ED, demonstrates high diagnostic accuracy for acute appendicitis, particularly among younger adults.