The role of imaging in diagnosing acute appendicitis: a tertiary care center study in Jeddah, Saudi Arabia

Objective: This study aimed to investigate the role of various diagnostic tools in reducing the negative appendectomy rate (NAR) at a tertiary care center in Jeddah, Saudi Arabia. Methods: A retrospective analysis was conducted on patients who underwent appendectomy at King Abdulaziz University Hospital (KAUH) between 2016 and 2021. Data on demographics, clinical presentation, pre-operative imaging (ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and histopathology results were collected. Results: A total of 495 patients were included in this study; 56.8% were males, and 70.2% were Saudis. The mean age of patients was 23.35 years (±13.802). The overall NAR was 4.8%, with CT demonstrating the lowest NAR (3.9%), followed by US (4.1%). Clinical diagnosis alone had an NAR of 4.4%. Females exhibited a higher NAR (7.5%) compared to males (2.5%), with a significant association between gender and histopathology results (p-value=0.02). The most common imaging modality was CT (51.3%), which showed a sensitivity of 96.1%. The US had a sensitivity of 95.9%, while the combination of US and CT yielded a sensitivity of 92.3%. The most frequent symptom was right lower quadrant (RLQ) pain (85%), and tenderness in this region was the most prevalent sign (74.4%). Conclusion: CT scans were the most accurate imaging tool for diagnosing acute appendicitis, with US serving as a reliable first-line option. Clinical diagnosis, when supported by scoring systems, also demonstrated high accuracy. These findings underscore the importance of integrating imaging with clinical assessment to optimize diagnostic precision and reduce unnecessary surgeries.