Diagnosis of Appendicitis in the ED: Comparison of Surgical and Nonsurgical Residents

The purpose of this study was to evaluate the impact of a surgery-based (SB) versus nonsurgery-based (NSB) training background of residents on the diagnosis of acute appendicitis in the emergency department (ED). The medical records of 641 adult patients who had undergone an appendectomy during a 3-year period (July 1996 to June 1999) were reviewed. All the patients were divided into NSB-in charge (n = 367) and SB-in charge (n = 274) groups, and demographic and clinical data recorded. Both groupsʹ patients showed no differences in either negative appendectomy or perforation rates. However, NSB group patients had longer in-hospital delays in comparison with SB group patients (12.0 ± 0.7 versus 9.6 ± 0.4 hours, P< .05). This longer stay time mainly occurred in the patients with negative exploration and uncomplicated appendicitis (P< .05). In both groups, patients with complicated appendicitis had longer prehospital delay of presentation than those with uncomplicated appendicitis. (2.0 ± 0.2 versus 1.2 ± 0.1 days in NSB group; 2.5 ± 0.5 versus 1.3 ± 0.2 days in SB group, P< .01). The NSB residents tended to order more computed tomography (CT) scans than SB residents (12% versus 5.1%, P< .05). With the application of a CT scan, the negative appendectomy rate was reduced significantly from 23% to 12%. We concluded that under the supervision of board-certified emergency physicians, the NSB residents had capabilities similar to SB residents in making correct diagnoses of acute appendicitis. In addition, close observation of equivocal cases in the ED did not necessarily increase the perforation rate.