Optimizing the Gold Standard—Low-Dose Computed Tomography Modalities as a Part of Clinical Practice in Acute Appendicitis Imaging

Haijanen, Jussi; Sula, Sami

doi:10.1001/jamasurg.2020.6358

Cited by 6 publications

(3 citation statements)

References 7 publications

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“…Even wellexperienced surgeons make their diagnosis on history, clinical examination and laboratory investigations have a diagnostic accuracy of less than 80% 9 . Computed Tomography is the standard radiological study to diagnose acute appendicitis 10 . Computed tomography (CT) is unavailable, especially in rural areas 11 .…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy Of Hyperbilirubinemia In Acute Appendicitis

Baseer,

Rehman,

Kalwar

et al. 2023

JRMC

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Objective: To determine the diagnostic accuracy of serum Bilirubin in cases of acute appendicitis keeping the histopathological findings as Gold standard. Study Design: Cross sectional validation study. Place and Duration of the Study: Surgical Unit, Sheikh Khalifa Bin Zayed Al-Nayhan Hospital (Combined Military Hospital), Rawalakot, Azad Kashmir, from Jan 2022 to June 2022. Methodology: A total of 380 patients aged between 18 to 65 years, who matched the inclusion and exclusion criteria suspected of acute appendicitis were included. Serum Bilirubin level was noted. Appendectomy was done. Specimen of appendix was sent for histopathology for confirmation of the diagnosis. Results: In our study, mean age of the patients was 34.015 with a standard deviation of 13.32. 65% (n=247) of the patients were males and 35% (n=133) were females. Frequency of acute appendicitis on histopathology was 82.89% (n=315) while 17.1% (n=65) had no findings of the disease. Validity of serum Bilirubin in diagnosing appendicitis using histopathology showed 57.36% (n=218) were true positive, 2.1% (n=8) were false positive, 15% (n=57) were true negative and 25.52 %( n=97) were false negative. Specificity, sensitivity, negative predictive value, positive predictive value, accuracy rate, positive likelihood ratio and negative likelihood ratio were 87.69%, 69.20%, 37.01%, 96.46%, 72.36%, 5.62 and 0.35 respectively. Conclusion: Serum Bilirubin is a useful marker for diagnosing the acute appendicitis and can be used as a good alternative diagnostic modality in suspected cases of acute appendicitis.

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Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy Of Hyperbilirubinemia In Acute Appendicitis

Baseer,

Rehman,

Kalwar

et al. 2023

JRMC

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“…Concerns about carcinogenic risk have prompted attempts to reduce CT radiation exposure used for the diagnosis of appendicitis. Some researchers have concluded that low-dose appendiceal CT (LDCT) should be implemented in all emergency departments and clinical trials [ 6 7 ]. However, the adoption of LDCT is disappointingly slow.…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence

2022

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Due to its excellent diagnostic performance, CT is the mainstay of diagnostic test in adults with suspected acute appendicitis in many countries. Although debatable, extensive epidemiological studies have suggested that CT radiation is carcinogenic, at least in children and adolescents. Setting aside the debate over the carcinogenic risk of CT radiation, the value of judicious use of CT radiation cannot be overstated for the diagnosis of appendicitis, considering that appendicitis is a very common disease, and that the vast majority of patients with suspected acute appendicitis are adolescents and young adults with average life expectancies. Given the accumulated evidence justifying the use of low-dose CT (LDCT) of only 2 mSv, there is no reasonable basis to insist on using radiation dose of multi-purpose abdominal CT for the diagnosis of appendicitis, particularly in adolescents and young adults. Published data strongly suggest that LDCT is comparable to conventional dose CT in terms of clinical outcomes and diagnostic performance. In this narrative review, we will discuss such evidence for reducing CT radiation in adolescents and young adults with suspected appendicitis.

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“…This finding adds further urgency to ongoing efforts to reduce radiation exposure in children, such as the Image Gently campaign. While the article’s Invited Commentary by Haijanen et al emphasizes optimizing low-dose CT protocols to reduce radiation exposure in children, there is abundant evidence from children’s hospitals that CT can be minimized or eliminated using combinations of diagnostic protocols, preimaging scoring systems, and alternate imaging modalities. These efforts and their benefits are relevant to this study’s findings and warrant discussion.…”

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confidence: 99%