Is There a Role for Abdominal Computed Tomographic Scans in Appendicitis?

Schuler, John G.; Shortsleeve, Michael J.; Goldenson, Richard S.; Perez-Rossello, Jeanette M.; Perlmutter, Robin A.; Thorsen, Amy J.

doi:10.1001/archsurg.133.4.373

Cited by 129 publications

(68 citation statements)

References 12 publications

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“…Twelve studies were case series without a control group. 30,[34][35][36][37][38][39][40][41][42][43][44] Three articles were reviews without any primary clinical data. 2,45,46 One article evaluated the clinical outcomes before and after the implementation of an ED protocol, but both arms of the study had identical rates of CT investigation.…”

Section: Excluded Studiesmentioning

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

132

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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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Section: Excluded Studiesmentioning

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

132

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“…However, some studies did not find any significant difference with the use of CT [6]. The sensitivity and specificity of CT for diagnosis of appendicitis is quite high, and reported to be 87-100% and 83-100% respectively [3,7,8]. The overall accuracy, positive predictive value and negative predictive value of CT were reported to be 94-98%, 92-98% and 95-100% respectively [8,9].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Computed Tomography on Surgeon’s Decisions in Suspected Appendicitis Cases

Öztürk¹

2015

Ann Clin Anal Med

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Anahtar KelimelerApendektomi; Tomografi; Karın Ağrısı Abstract Aim: The purpose of this study is to evaluate the effect of computed tomography (CT) on the diagnosis and treatment plan of surgeons in patients with suspected appendicitis. Material and Method: Our study was conducted between 2010 -2011. One hundred twenty five patients suspected appendicitis and underwent abdominal computed tomography scanning were enrolled. The effects of CT scanning on the diagnosis and treatment plan of surgeons were evaluated. Results: After CT scanning the findings of appendicitis was revealed in 89 patients were not revealed in 36. Eighty eight patients diagnosed with acute appendicitis after a CT scan and the 5 patients with clinical suspect of appendicitis which is not confirmed by CT scan were operated (total 93 patients). In according to histopathological findings acute appendicitis were confirmed in 83 patients and were not confirmed acute appendicitis in 10 patients. According to our study, CT has changed the diagnosis and treatment plan in 98 patients (78.4%) with suspected appendicitis. The diagnosis of acute appendicitis was confirmed in 65 (52%) of these patients, and treatment was started ending the observation. Diagnostic and treatment plan was changed in 33 patients and CT did not affect surgeon's decision in 27 (21.6%) patients. Discussion: CT is a diagnostic method which affects the diagnosis and treatment of patients with suspected appendicitis. We recommend CT scans without waiting in patients with suspected acute appendicitis.

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“…A pesar del abordaje tecnológico actual para el diagnóstico de una patología tan común como la AA [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] , su diagnóstico temprano y acertado es todavía un problema y un desafío 3,7,31 . Las tasas de perforación, apéndices normales y laparotomías negativas varían entre 15% a 40% [4][5][6][7]31,34 .…”

Section: Discussionunclassified

“…precoz de AA y reducir las tasas de diagnósticos tardíos y falsos, se introdujeron técnicas radiológi-cas, estudios de laboratorio y laparoscopia [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] . A pesar de este abordaje tecnológico todavía se operan apéndices normales y perforados 3,15 .…”

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Puntuación diagnóstica para apendicitis: estudio prospectivo de su aplicación por profesionales de salud no-médicos

Beltrán¹,

M²,

Cruces³

2006

Rev. méd. Chile

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Is There a Role for Abdominal Computed Tomographic Scans in Appendicitis?

Cited by 129 publications

References 12 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

The Effect of Computed Tomography on Surgeon’s Decisions in Suspected Appendicitis Cases

Puntuación diagnóstica para apendicitis: estudio prospectivo de su aplicación por profesionales de salud no-médicos

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