A Prospective Randomized Study of Clinical Assessment versus Computed Tomography for the Diagnosis of Acute Appendicitis

RESEARCH • RECHERCHEImpact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis Background: Clinical evaluation alone is still considered adequate by many clinicians who treat patients with appendicitis. The impact of computed tomography (CT) on clinical outcomes remains unclear, and there is no consensus regarding the appropriate use of CT in these patients. We sought to evaluate the impact of abdominal CT on the clinical outcomes of patients presenting with suspected appendicitis. Methods:We conducted a systematic review of the literature to identify studies that examined clinical outcomes related to the use of abdominal CT in the diagnosis of acute appendicitis. Inclusion criteria were studies of adult patients with suspected appendicitis that evaluated the impact of abdominal CT on negative appendectomy rates, perforation rates or time to surgery. Two independent investigators reviewed all titles and abstracts and extracted data from 28 full-text articles. Statistical analysis was conducted using Review Manager 5.0.10 software. Results:The negative appendectomy rate was 8.7% when using CT compared with 16.7% when using clinical evaluation alone (p < 0.001). There was also a significantly lower negative appendectomy rate during the CT era compared with the pre-CT era (10.0% v. 21.5%, p < 0.001). Time to surgery was evaluated in 10 of the 28 studies, 5 of which demonstrated a significant increase in the time to surgery with the use of CT. Appendiceal perforation rates were unchanged by the use of CT (23.4% in the CT group v. 16.7% in the clinical evaluation group, p = 0.15). Similarly, the perforation rate during the CT era was not significantly different than that during the pre-CT era (20.0% v. 19.6%, p = 0.74). Conclusion:This meta-analysis supports the hypothesis that the use of preoperative abdominal CT is associated with lower negative appendectomy rates. The use of CT in the absence of an expedited imaging protocol may delay surgery, but this delay is not associated with increased appendiceal perforation rates. Routine CT in all patients presenting with suspected appendicitis could reduce the rate of unnecessary surgery without increasing morbidity. Contexte :Beaucoup de cliniciens qui traitent des patients atteints d'appendicite considèrent toujours que l'évaluation clinique seule suffit. L'effet de la tomodensitométrie (TDM) sur les résultats cliniques n'est toujours pas clair et il n'y a pas de consensus au sujet de l'utilisation appropriée de la TDM chez ces patients. Nous avons cherché à évaluer l'effet de la TDM abdominale sur les résultats cliniques des patients chez qui l'on soupçonne une appendicite.Méthodes : Nous avons procédé à une synthèse systématique des publications pour trouver des études où l'on examinait les résultats cliniques reliés à l'utilisation de la TDM abdominale pour diagnostiquer l'appendicite aiguë. Les études portant sur des patients adultes chez lesquels on soupçonnait une appendicite qui ont évalué l...

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“…9,12,16,18,19,[21][22][23]25,29 Five studies reported statistically longer time in the CT group (Fig. 4).…”

Section: Time To the Operating Roommentioning

confidence: 99%

Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis

Krajewski

2011

Can J Surg

128

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“…In a prospective, randomized study comparing clinical examination and CT for the diagnosis of acute appendicitis, CT did not increase the accuracy of the diagnosis [17]. CT was not used in our study.…”

Section: Discussionmentioning

confidence: 75%

Effect of Time in the Development of Perforated Appendicitis

Atahan

2012

J Curr Surg

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“…Patients scoring 7 or more were assumed to have acute appendicitis and were included in the study. 23,24,25 A visual analog scale (VAS) score was used for evaluating pain. It is based on the principle that 'by 7 to 8 years old, children are usually able to rate their pain on a 0-10 numeric scale, with 0=no pain and 10=worst pain that can be imagined'.…”

Section: Introductionmentioning

confidence: 99%

Pre operative use of injection diclofenac versus injection tramadol for pain management of acute appendicitis in emergency department

et al. 2017

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A Prospective Randomized Study of Clinical Assessment versus Computed Tomography for the Diagnosis of Acute Appendicitis

Cited by 100 publications

References 25 publications

Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis

Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis

Effect of Time in the Development of Perforated Appendicitis

Pre operative use of injection diclofenac versus injection tramadol for pain management of acute appendicitis in emergency department

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