The Accuracy of Low-dose Computed Tomography Protocol in Patients With Suspected Acute Appendicitis

Sippola, Suvi; Virtanen, Johanna; Tammilehto, Ville; Grönroos, Juha; Hurme, Saija; Niiniviita, Hannele; Lietzén, Elina

doi:10.1097/sla.0000000000002976

Cited by 40 publications

(31 citation statements)

References 47 publications

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“…The OPTICAP randomized trial has shown that a low-dose protocol using intravenous contrast media was not inferior to the standard protocol in terms of diagnostic accuracy (79% accurate diagnosis in lowdose and 80% in standard CT by a primary radiologist) and accuracy to categorize AA severity (79% for both protocols). However, the mean radiation dose of lowdose CT was significantly lower compared with standard CT (3.33 and 4.44 mSv, respectively) [12]. The radiation dose of appendiceal CT for adolescents and young adults can be reduced to 2 mSv without impairing clinical outcomes and reducing the potential risk of exposure to ionizing radiation simultaneously [68].…”

Section: Q14: What Is the Role Of Serum Biomarkers In Evaluating Pementioning

confidence: 96%

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Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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Background and aims: Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of nonoperative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and perioperative antibiotic therapy.

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Section: Q14: What Is the Role Of Serum Biomarkers In Evaluating Pementioning

confidence: 96%

“…Many simple and user-friendly scoring systems have been used as a structured algorithm in order to aid in predicting the risk of AA, but none has been widely accepted [8][9][10]. The role of diagnostic imaging, such as ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI), is another major controversy [11,12].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

et al. 2020

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“…This corresponds to the recent literature [ 9 , 23 , 24 ]. Here, the use of low-dose CT protocols can reduce the radiation exposure with a comparable diagnostic accuracy with standard CT protocols [ 25 ]. These protocols could be a cost-efficient alternative to inpatient observation in patients with intermediate probability for AA.…”

Section: Discussionmentioning

confidence: 99%

DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis

Malkomes

Edmaier

Liese

et al. 2020

Langenbecks Arch Surg

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Purpose The management of patients with suspected appendicitis remains a challenge in daily clinical practice, and the optimal management algorithm is still being debated. Negative appendectomy rates (NAR) continue to range between 10 and 15%. This prospective study evaluated the accuracy of a diagnostic pathway in acute appendicitis using clinical risk stratification (Alvarado score), routine ultrasonography, gynecology consult for females, and selected CT after clinical reassessment. Methods Patients presenting with suspected appendicitis between November 2015 and September 2017 from age 18 years and above were included. Decision-making followed a clear management pathway. Patients were followed up for 6 months after discharge. The hypothesis was that the algorithm can reduce the NAR to a value of under 10%. Results A total of 183 patients were included. In 65 of 69 appendectomies, acute appendicitis was confirmed by histopathology, corresponding to a NAR of 5.8%. Notably, all 4 NAR appendectomies had other pathologies of the appendix. The perforation rate was 24.6%. Only 36 patients (19.7%) received a CT scan. The follow-up rate after 30 days achieved 69%, including no patients with missed appendicitis. The sensitivity and specificity of the diagnostic pathway was 100% and 96.6%, respectively. The potential saving in costs can be as much as 19.8 million €/100,000 cases presenting with the suspicion of appendicitis. Conclusion The risk-stratified diagnostic algorithm yields a high diagnostic accuracy for patients with suspicion of appendicitis. Its implementation can safely reduce the NAR, simultaneously minimizing the use of CT scans and optimizing healthcare-related costs in the treatment of acute appendicitis. Trial registration ClinicalTrials.gov Identifier: NCT02627781 (December 2015)

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“…Even if patients can be pointed out being at "high risk" of having acute appendicitis based on a three-zone clinical score, a low-dose computed tomography (CT) scan (or step-wise conditional CT after initial ultrasound (US)) seems less harmful than standard "diagnostic" surgery. Surgery without imaging is accompanied by higher NArs compared to the known rates after a standard imaging approach (14,28). This argument is illustrated by comparing two prospective national SNApSHOT audits (14).…”

Section: The Three Test Zone Concept (Low- Intermediate- and Highrisk Scores)mentioning

confidence: 99%

Diagnosis of Uncomplicated and Complicated Appendicitis in Adults

2021

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Background: Diagnostic work-up of acute appendicitis remains challenging. While some guidelines advise to use a risk stratification based on clinical parameters, others use standard imaging in all patients. As non-operative management of uncomplicated appendicitis has been identified as feasible and safe, differentiation between uncomplicated and complicated appendicitis is of paramount importance. We reviewed the literature to describe the optimal strategy for diagnosis of acute appendicitis. Methods: A narrative review about the diagnosis of acute appendicitis in adult patients was conducted. Both diagnostic strategies and goals were analyzed. Results: For diagnosing acute appendicitis, both ruling in and ruling out the disease are important. Clinical and laboratory findings individually do not suffice, but when combined in a diagnostic score, a better risk prediction can be made for having acute appendicitis. However, for accurate diagnosis imaging seems obligatory in patients suspected for acute appendicitis. Scoring systems combining clinical and imaging features may differentiate between uncomplicated and complicated appendicitis and may enable ruling out complicated appendicitis. Within conservatively treated patients with uncomplicated appendicitis, predictive factors for non-responsiveness to antibiotics and recurrence of appendicitis need to be defined in order to optimize treatment outcomes. Conclusion: Standard imaging increases the diagnostic power for both ruling in and ruling out acute appendicitis. Incorporating imaging features in clinical scoring models may provide better differentiation between uncomplicated and complicated appendicitis. Optimizing patient selection for antibiotic treatment of appendicitis may minimize recurrence rates, resulting in better treatment outcomes.

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The Accuracy of Low-dose Computed Tomography Protocol in Patients With Suspected Acute Appendicitis

Cited by 40 publications

References 47 publications

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

DIALAPP: a prospective validation of a new diagnostic algorithm for acute appendicitis

Diagnosis of Uncomplicated and Complicated Appendicitis in Adults

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