Routine versus Selective Abdominal Computed Tomography Scan in the Evaluation of Right Lower Quadrant Pain: A Randomized Controlled Trial

Lee, Christopher C.; Golub, Robert M.; Singer, Adam J.; Cantu, Roberto; Levinson, Howard

doi:10.1197/j.aem.2006.08.007

Cited by 49 publications

(35 citation statements)

References 37 publications

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“…A recent RCT performed by Lee and colleagues 19 compared mandatory and selective CT for adult patients presenting with acute RLQ pain of less than 72 hours' duration and suspected appendicitis. There were 80 patients randomly assigned to the selective CT imaging group, and 72 were randomly assigned to the mandatory imaging group.…”

Section: Discussionmentioning

confidence: 99%

“…In the RCT by Lee and colleagues, 19 there was no significant delay to surgery in patients who underwent CT. This could be because this is a more recent study and CT scans are now more easily obtained.…”

Section: Researchmentioning

confidence: 99%

“…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%

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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: Discussionmentioning

confidence: 99%

Section: Researchmentioning

confidence: 99%

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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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“…Several studies have shown that the routine use of imaging has a positive effect on patient outcomes, with two randomized controlled trials reporting substantially lower negative appendectomy rates with routine imaging in all patients, compared to selective use of imaging based on clinical judgment. 10,11 The optimal imaging strategy for patients suspected of having appendicitis has been debated in recent years. Computed tomography (CT) has been shown to be more accurate than ultrasound (US), but its ionizing radiation exposure is associated with the induction of cancer.…”

Section: Resultsmentioning

confidence: 99%

A Simple Clinical Decision Rule To Rule Out Appendicitis In Patients With Nondiagnostic Ultrasound Results

et al. 2014

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“…While many have reported excellent outcomes when using CT for diagnosing appendicitis, which is reflected by the results of a recent meta-analysis, others have failed to correlate the increased use of CT with improved diagnostic accuracy on a population level [165][166][167] . Furthermore, only a few randomised controlled studies have compared the use of CT with clinical assessment, and the results are conflicting [168][169][170] .…”

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confidence: 99%

Structured management of patients with suspected acute appendicitis

Andersson¹

2015

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Routine versus Selective Abdominal Computed Tomography Scan in the Evaluation of Right Lower Quadrant Pain: A Randomized Controlled Trial

Abstract: In this small sample of adult patients with RLQ abdominal pain and suspected acute appendicitis, CT imaging was performed less frequently in the selective group and there was a trend with mandatory CT imaging to reduced rates of negative appendectomy and perforated appendices.

Cited by 49 publications

References 37 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

A Simple Clinical Decision Rule To Rule Out Appendicitis In Patients With Nondiagnostic Ultrasound Results

Structured management of patients with suspected acute appendicitis

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