Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

Abstract

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

The Dynamics of Inflammatory Markers in Patients with Suspected Acute Appendicitis

“…This study confirms the results of previous research, where the diagnostic accuracy of inflammatory mediators reaches 75% [7,[24][25][26]. The addition of a conditional CT protocol in this group of patients resulted in a diagnostic accuracy of 96% and the overall use of CT of 29% for diagnosis [19]. This is very similar to other series, where the use of CT scans resulted in high diagnostic effectiveness [12,16,17,[27][28][29][30].…”

“…This is a pre-planned analysis of inflammatory markers' data, which were obtained from a cohort of patients from our previous research [19]. In short, all patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018.…”

“…CT has high sensitivity and specificity (about 90-95% and 94%, respectively) in visualizing AA, however, it uses ionizing radiation and is associated with an increased risk of future oncological diseases, especially in young patients [16][17][18]. Conditional use of CT scanning after US could be a possible solution for this problem [19].…”

Suspected and Confirmed Acute Appendicitis During the COVID-19 Pandemic: First and Second Quarantines—a Prospective Study

“…Another reason for this is our institution's policy of the liberal use of CT if the diagnosis is not clear after US. MRI is used for pregnant patients after equivocal US (27)(28)(29).…”

Self-Locking Polymeric Clips Are Safe for the Closure of Appendiceal Stump in Laparoscopic Appendectomy

“…The study was approved by the Vilnius Regional Ethics Committee (2019/3-1107-610) in March 2019. All patients treated for acute appendicitis at a tertiary care hospital of Vilnius University Santara clinics (Lithuania) were entered into the prospectively maintained database [ 18 ]. Patients who underwent laparoscopic surgery for acute appendicitis from June 2016 to April 2021 and met the inclusion criteria ( Table 1 ) were included in this study.…”