Abstract
Introduction: Acute appendicitis remains one of the most common causes of acute abdominal pain requiring urgent evaluation, and timely diagnosis is essential to prevent complications. Clinical assessment and imaging are routinely used to support diagnostic decision‑making, yet their accuracy varies by settings and patient population.
Objectives: This study aimed to evaluate the diagnostic performance of physical examination and sonographic assessment in identifying acute appendicitis using pathology as the reference standard.
Patients and Methods: The study used a cross‑sectional diagnostic design and included 190 patients with suspected appendicitis who presented to Shahid Mohammadi hospital between March 2021 and March 2025. Demographic characteristics, sonographic findings, physical examination results, and pathology reports were retrospectively extracted from hospital clinical archives. Agreement between each diagnostic modality and pathology was evaluated using Cohen’s kappa coefficient, and diagnostic performance, including accuracy, sensitivity, specificity, positive and negative predictive values (PPV and NPV), and likelihood ratios, was calculated for both sonography and physical.
Results: The agreement analysis of 190 suspected appendicitis cases showed that both modalities demonstrated significant concordance with pathology, with sonography achieving a Cohen’s kappa of 0.726 and physical examination showing an even stronger agreement at 0.821. Using pathology as the diagnostic reference standard, sonography achieved an accuracy of 86.31%, sensitivity of 87.4%, specificity of 85.3%, a PPV of 85.6%, and a NPV of 14.4%. In comparison, physical examination demonstrated superior diagnostic performance, with 91% accuracy, 90.5% sensitivity, 91.6% specificity, a PPV of 91.5%, and a NPV of 90.6%.
Conclusion: Both sonography and physical examination demonstrated meaningful diagnostic value when assessed against pathology as the reference standard, supporting their utility as reliable clinical tools for identifying suspected appendicitis.