Skip to main content
Erschienen in: World Journal of Surgery 2/2008

01.02.2008

Artificial Neural Networks: Useful Aid in Diagnosing Acute Appendicitis

verfasst von: S. G. Prabhudesai, S. Gould, S. Rekhraj, P. P. Tekkis, G. Glazer, P. Ziprin

Erschienen in: World Journal of Surgery | Ausgabe 2/2008

Einloggen, um Zugang zu erhalten

Abstract

Backround

The purpose of the study was to assess the role of artificial neural networks (ANNs) in the diagnosis of appendicitis in patients presenting with acute right iliac fossa (RIF) pain and comparing its performance with the assessment made by experienced clinicians and the Alvarado score.

Methods

After training and testing an ANN, data from 60 patients presenting with suspected appendicitis over a 6-month period to a teaching hospital was collected prospectively. Accuracy of diagnosing appendicitis by the clinician, the Alvarado score, and the ANN was compared.

Results

The sensitivity, specificity, and positive and negative predictive values of the ANN were 100%, 97.2%, 96.0%, and 100% respectively. The ability of the ANN to exclude accurately the diagnosis of appendicitis in patients without true appendicitis was statistically significant compared to the clinical performance (p = 0.031) and Alvarado score of ≥6 (p = 0.004) and nearly significant compared to the Alvarado score of ≥7 (p = 0.063).

Conclusions

ANNs can be an effective tool for accurately diagnosing appendicitis and may reduce unnecessary appendectomies.
Literatur
1.
Zurück zum Zitat Colson M, Skinner KA, Dunnington G (1997) High negative appendectomy rates are no longer acceptable. Am J Surg 174:723–726PubMedCrossRef Colson M, Skinner KA, Dunnington G (1997) High negative appendectomy rates are no longer acceptable. Am J Surg 174:723–726PubMedCrossRef
2.
Zurück zum Zitat Andersson RE, Hugander AP, Ghazi SH, et al (1999) Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World J Surg 23:133–140PubMedCrossRef Andersson RE, Hugander AP, Ghazi SH, et al (1999) Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World J Surg 23:133–140PubMedCrossRef
3.
Zurück zum Zitat Jahn H, Mathiesen FK, Neckelmann K, et al (1997) Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis: experience with a score-aided diagnosis. Eur J Surg 163: 433–443PubMed Jahn H, Mathiesen FK, Neckelmann K, et al (1997) Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis: experience with a score-aided diagnosis. Eur J Surg 163: 433–443PubMed
4.
Zurück zum Zitat Hale DA, Molloy M, Pearl RH, et al (1997) Appendectomy: a contemporary appraisal. Ann Surg 225:252–261PubMedCrossRef Hale DA, Molloy M, Pearl RH, et al (1997) Appendectomy: a contemporary appraisal. Ann Surg 225:252–261PubMedCrossRef
5.
Zurück zum Zitat Leape LL, Ramenofsky ML (1980) Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate? Ann Surg 191:410–143PubMedCrossRef Leape LL, Ramenofsky ML (1980) Laparoscopy for questionable appendicitis: can it reduce the negative appendectomy rate? Ann Surg 191:410–143PubMedCrossRef
6.
Zurück zum Zitat Deutsch AA, Zelikovsky A, Reiss R (1982) Laparoscopy in the prevention of unnecessary appendicectomies: a prospective study. Br J Surg 69:336–337PubMedCrossRef Deutsch AA, Zelikovsky A, Reiss R (1982) Laparoscopy in the prevention of unnecessary appendicectomies: a prospective study. Br J Surg 69:336–337PubMedCrossRef
7.
Zurück zum Zitat Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564PubMedCrossRef Alvarado A (1986) A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med 15:557–564PubMedCrossRef
8.
Zurück zum Zitat Fenyö G, Lindberg G, Blind P, et al (1997) Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system. Eur J Surg 163:831–838PubMed Fenyö G, Lindberg G, Blind P, et al (1997) Diagnostic decision support in suspected acute appendicitis: validation of a simplified scoring system. Eur J Surg 163:831–838PubMed
9.
Zurück zum Zitat de Dombal FT, Leaper DJ, Staniland JR, et al (1972) Computer-aided diagnosis of acute abdominal pain. Br J Surg 2:9–13 de Dombal FT, Leaper DJ, Staniland JR, et al (1972) Computer-aided diagnosis of acute abdominal pain. Br J Surg 2:9–13
10.
Zurück zum Zitat Birnbaum BA, Jeffrey RB Jr (1998) CT and sonographic evaluation of acute right lower quadrant abdominal pain. AJR Am J Roentgenol 170:361–371PubMed Birnbaum BA, Jeffrey RB Jr (1998) CT and sonographic evaluation of acute right lower quadrant abdominal pain. AJR Am J Roentgenol 170:361–371PubMed
11.
Zurück zum Zitat Jeffrey RB Jr, Laing FC, Townsend RR (1988) Acute appendicitis: sonographic criteria based on 250 cases. Radiology 167:327–329PubMed Jeffrey RB Jr, Laing FC, Townsend RR (1988) Acute appendicitis: sonographic criteria based on 250 cases. Radiology 167:327–329PubMed
12.
Zurück zum Zitat Rioux M (1992) Sonographic detection of the normal and abnormal appendix. AJR Am J Roentgenol 158:773–778PubMed Rioux M (1992) Sonographic detection of the normal and abnormal appendix. AJR Am J Roentgenol 158:773–778PubMed
13.
Zurück zum Zitat Rao PM, Rhea JT, Novelline RA, et al (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146PubMedCrossRef Rao PM, Rhea JT, Novelline RA, et al (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338:141–146PubMedCrossRef
14.
Zurück zum Zitat Baxt WG (1991) Use of an artificial neural network for the diagnosis of myocardial infarction. Ann Intern Med 115:843–848PubMed Baxt WG (1991) Use of an artificial neural network for the diagnosis of myocardial infarction. Ann Intern Med 115:843–848PubMed
15.
Zurück zum Zitat Patil S, Henry JW, Rubenfire M, et al (1993) Neural network in the clinical diagnosis of acute pulmonary embolism. Chest 104:1685–1689PubMedCrossRef Patil S, Henry JW, Rubenfire M, et al (1993) Neural network in the clinical diagnosis of acute pulmonary embolism. Chest 104:1685–1689PubMedCrossRef
16.
Zurück zum Zitat Burke HB (1994) Artificial neural networks for cancer research: outcome prediction. Semin Surg Oncol 10:73–79PubMedCrossRef Burke HB (1994) Artificial neural networks for cancer research: outcome prediction. Semin Surg Oncol 10:73–79PubMedCrossRef
17.
Zurück zum Zitat Doyle HR, Dvorchik I, Mitchell S, et al (1994) Predicting outcomes after liver transplantation: a connectionist approach. Ann Surg 2:504–508 Doyle HR, Dvorchik I, Mitchell S, et al (1994) Predicting outcomes after liver transplantation: a connectionist approach. Ann Surg 2:504–508
19.
Zurück zum Zitat Eberhart RC, Dobbins RW, Hutton LV (1991) Neural network paradigm comparisons for appendicitis diagnoses. In: Proceedings of 4th Annual IEEE Symposium on Computer-Based Systems, pp 298–304 Eberhart RC, Dobbins RW, Hutton LV (1991) Neural network paradigm comparisons for appendicitis diagnoses. In: Proceedings of 4th Annual IEEE Symposium on Computer-Based Systems, pp 298–304
20.
Zurück zum Zitat Dixon JM, Elton RA, Rainey JB, et al (1991) Rectal examination in patients with pain in the right lower quadrant of the abdomen. BMJ 302:386–388PubMedCrossRef Dixon JM, Elton RA, Rainey JB, et al (1991) Rectal examination in patients with pain in the right lower quadrant of the abdomen. BMJ 302:386–388PubMedCrossRef
21.
Zurück zum Zitat Andersson RE, Hugander AP, Ghazi SH, et al (1999) Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World J Surg 23:133–140PubMedCrossRef Andersson RE, Hugander AP, Ghazi SH, et al (1999) Diagnostic value of disease history, clinical presentation, and inflammatory parameters of appendicitis. World J Surg 23:133–140PubMedCrossRef
22.
Zurück zum Zitat Kalan M, Talbot D (1994) Evaluation of modified Alvarado score in the diagnoses of acute appendicitis. Ann R Coll Surg Engl 76:418–19PubMed Kalan M, Talbot D (1994) Evaluation of modified Alvarado score in the diagnoses of acute appendicitis. Ann R Coll Surg Engl 76:418–19PubMed
23.
Zurück zum Zitat Owen TD, Williams H, Stiff G, et al (1992) Evaluation of Alvarado score in acute appendicitis. J R Soc Med 85:87–88PubMed Owen TD, Williams H, Stiff G, et al (1992) Evaluation of Alvarado score in acute appendicitis. J R Soc Med 85:87–88PubMed
24.
Zurück zum Zitat John H, Neff U, Kelemen M (1993) Appendicitis diagnosis today: clinical and ultrasound deductions. World J Surg 17:243–249PubMedCrossRef John H, Neff U, Kelemen M (1993) Appendicitis diagnosis today: clinical and ultrasound deductions. World J Surg 17:243–249PubMedCrossRef
25.
Zurück zum Zitat Pesonen E, Ohmann C, Eskelinen M, et al (1998) Diagnosis of acute appendicitis in two databases: evaluation of different neighbourhoods with an LVQ neural network. Methods Inf Med 37:59–63PubMed Pesonen E, Ohmann C, Eskelinen M, et al (1998) Diagnosis of acute appendicitis in two databases: evaluation of different neighbourhoods with an LVQ neural network. Methods Inf Med 37:59–63PubMed
26.
Zurück zum Zitat Sheridan WG, White AT, Havard T, et al (1992) Nonspecific abdominal pain: the resource implications. Ann R Coll Surg Engl 74:181–185PubMed Sheridan WG, White AT, Havard T, et al (1992) Nonspecific abdominal pain: the resource implications. Ann R Coll Surg Engl 74:181–185PubMed
28.
Zurück zum Zitat Denizbasi A, Unleur EE (2003) The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. Eur J Emerg Med 10:296–301PubMedCrossRef Denizbasi A, Unleur EE (2003) The role of the emergency medicine resident using the Alvarado score in the diagnosis of acute appendicitis compared with the general surgery resident. Eur J Emerg Med 10:296–301PubMedCrossRef
29.
Zurück zum Zitat Chan MY, Teo BS, Ng BL (2001) The Alvarado score and acute appendicitis. Ann Acad Med Singapore 30:510–512PubMed Chan MY, Teo BS, Ng BL (2001) The Alvarado score and acute appendicitis. Ann Acad Med Singapore 30:510–512PubMed
30.
Zurück zum Zitat Hale DA, Molloy M, Pearl RH, et al (1997) Appendectomy: a contemporary appraisal. Ann Surg 225:252–261PubMedCrossRef Hale DA, Molloy M, Pearl RH, et al (1997) Appendectomy: a contemporary appraisal. Ann Surg 225:252–261PubMedCrossRef
31.
Zurück zum Zitat Jones PF (2001) Suspected acute appendicitis: trends in management over 30 years. Br J Surg 88:1570–1577PubMedCrossRef Jones PF (2001) Suspected acute appendicitis: trends in management over 30 years. Br J Surg 88:1570–1577PubMedCrossRef
32.
Zurück zum Zitat McGreevy JM, Finlayson SR, Alvarado R, et al (2002) Laparoscopy may be lowering the threshold to operate on patients with suspected appendicitis. Surg Endosc 16:1046–1049PubMedCrossRef McGreevy JM, Finlayson SR, Alvarado R, et al (2002) Laparoscopy may be lowering the threshold to operate on patients with suspected appendicitis. Surg Endosc 16:1046–1049PubMedCrossRef
33.
Zurück zum Zitat Gammerman A, Thatcher AR (1991) Bayesian diagnostic probabilities without assuming independence of symptoms. Methods Inf Med 30:15–22PubMed Gammerman A, Thatcher AR (1991) Bayesian diagnostic probabilities without assuming independence of symptoms. Methods Inf Med 30:15–22PubMed
34.
Zurück zum Zitat Cross SS, Harrison RF, Kennedy RL (1995) Introduction to neural networks. Lancet 346:1135–138lCrossRef Cross SS, Harrison RF, Kennedy RL (1995) Introduction to neural networks. Lancet 346:1135–138lCrossRef
Metadaten
Titel
Artificial Neural Networks: Useful Aid in Diagnosing Acute Appendicitis
verfasst von
S. G. Prabhudesai
S. Gould
S. Rekhraj
P. P. Tekkis
G. Glazer
P. Ziprin
Publikationsdatum
01.02.2008
Verlag
Springer-Verlag
Erschienen in
World Journal of Surgery / Ausgabe 2/2008
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-007-9298-6

Weitere Artikel der Ausgabe 2/2008

World Journal of Surgery 2/2008 Zur Ausgabe

Letter

Reply

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.