Imaging for Suspected Appendicitis: Negative Appendectomy and Perforation Rates

Bendeck, Sandra E.; Nino-Murcia, Matilde; Berry, Gerald J.; Jeffrey, R. Brooke

doi:10.1148/radiol.2251011780

Cited by 192 publications

(117 citation statements)

References 27 publications

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“…[21,22] While US is the most frequently used imaging method to confirm the diagnosis, diagnostic accuracy rates (71% and 97%) are limited by practitioner experience, localization of the appendix, the patient's body mass index, and density of bowel gases. [23][24][25] CT is a more reliable imaging method for diagnosing acute appendicitis, having a diagnostic accuracy rate of 93-98%.…”

Section: Discussionmentioning

confidence: 99%

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

Kırkıl¹,

Karabulut²,

Aygen³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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Section: Discussionmentioning

confidence: 99%

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

Kırkıl¹,

Karabulut²,

Aygen³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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“…CT-A/P has become an important diagnostic tool to diagnose or exclude acute appendicitis, with a sensitivity and negative predictive value that surpasses compression sonography and clinical exam [4][5][6][7]. The rates of negative appendectomies have decreased from up to 20% to as low as 1.7% when using preoperative CT scans [8,9]. Evaluation of equivocal CT-A/P studies in patients with right lower quadrant pain and suspected appendicitis may benefit from subspecialist consultation, particularly in the academic setting where preliminary interpretations are carried out by resident physicians [6,10,11].…”

Section: Introductionmentioning

confidence: 99%

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Choudhri

Carr

et al. 2011

J Digit Imaging

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Advances in handheld computing now allow review of DICOM datasets from remote locations. As the diagnostic ability of this tool is unproven, we evaluated the ability to diagnose acute appendicitis on abdominal CT using a mobile DICOM viewer. This HIPAA compliant study was IRB-approved. Twenty-five abdominal CT studies from patients with RLQ pain were interpreted on a handheld device (iPhone) using a DICOM viewer (OsiriX mobile) by five radiologists. All patients had surgical confirmation of acute appendicitis or follow-up confirming no acute appendicitis. Studies were evaluated for the ability to find the appendix, maximum appendiceal diameter, presence of an appendicolith, periappendiceal stranding and fluid, abscess, and an assessment of the diagnosis of acute appendicitis. Results were compared to PACS workstation. Fifteen cases of acute appendicitis were correctly identified on 98% of interpretations, with no false-positives. Eight appendicoliths were correctly identified on 88% of interpretations. Three abscesses were correctly identified by all readers. Handheld device measurement of appendiceal diameter had a mean 8.6% larger than PACS measurements (p=0.035). Evaluation for acute appendicitis on abdominal CT studies using a portable device DICOM viewer can be performed with good concordance to reads performed on PACS workstations.

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“…According to previous studies (14,15), most diagnostic delay is rooted in delayed presentation of patient; delays due to hospital procedures are not significant contributors to incidence of perforation. Perforation is a serious complication of acute appendicitis, and is observed 20% more frequently in children and elderly patients (16,17). Time from onset of symptoms to emergency admission was 4.94 ± 1.84 hours.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Clinical and Imaging Findings in Children with Diagnosis of Acute Appendicitis

et al. 2017

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Objectives: This study is an evaluation of the accuracy of ultrasonography (USG), computed tomography (CT), and Alvarado score (AS) in the diagnosis and management of acute appendicitis in children. Methods: Records of pediatric patients admitted to the pediatric emergency department (ED) between 2008 and 2012 were evaluated retrospectively. Patient data from the national electronic health information system was screened and those with complete clinical and imaging findings (AS, preoperative USG and/or CT images) and postoperative pathological diagnosis were included in the study. Results: Study group consisted of 449 children with diagnosis of suspected acute appendicitis aged between 3 and 15 years (mean age: 9.20 ± 2.73 years). Of the total, 428 (95.3%) patients underwent appendectomy and 21 (4.7%) cases were treated conservatively. Mean duration of symptoms was 4.94 ± 1.84 hours. Pathological evaluation results were negative (i.e., removal of normal appendix) in 36 (8.4%) patients; histopathological diagnosis was acute appendicitis in 392 (91.6%) patients. Perforated appendix was found in 38 (8.5%) patients. In patients with histopathologically confirmed appendicitis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT in diagnosis of acute appendicitis were 96.3%, 55.6%, 92.8%, and 71.4%, respectively. Sensitivity, specificity, PPV, and NPV of USG were 73.5%, 22.2%, 91.1%, and 69.2%, respectively. Negative appendectomy rate was 6.4% (n = 8) in patients who had preoperative CT scan, and 6.5% (n = 28) in patients who had USG examination. Conclusions: CT has higher sensitivity than USG in diagnosis of acute appendicitis. USG, on the other hand, is widely accessible method and does not use ionizing radiation. Therefore, it may be used as initial radiological imaging method in acute appendicitis. Thin-filter, contrast-unenhanced CT scans may be preferred in cases where clinical signs and USG findings are unclear or controversial.

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Imaging for Suspected Appendicitis: Negative Appendectomy and Perforation Rates

Cited by 192 publications

References 27 publications

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

The appendicitis scores may be useful in reducing the costs of treatment for right lower quadrant pain

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Evaluation of Clinical and Imaging Findings in Children with Diagnosis of Acute Appendicitis

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