The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis

Peck, Jennifer D.; Peck, Andrew; Peck, Colleen; Peck, James J.

doi:10.1016/s0002-9610(00)00435-9

Cited by 77 publications

(37 citation statements)

References 10 publications

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“…During the late 1990s and early 2000s, the CT scaning rate in patients with suspected appendicitis increased from less than 10% to over 50% at many institutions. 5,25,51 Comparative studies published in the past 10 years have demonstrated a mean uniform decrease in the negative appendectomy rate after the widespread implementation of CT. Our review demonstrated a significant decrease in the negative appendectomy rate from 21.5% during the pre-CT era to 10.0% during the CT era (p < 0.001), and there was significant heterogeneity for this outcome in this analysis. The article that most affected heterogeneity was that of Perez and colleagues, 25 which, when removed, decreased but did not eliminate heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…5,11,22,[24][25][26][27]30,31,33 The mean CT rate during the pre-CT era was 7.6% (range 0%-31.6%) and increased to 53.6% (range 33.6%-83.8%) during the CT era. Including all studies, 4485 patients were evaluated during the pre-CT era, and 1629 patients were evaluated during the CT era.…”

Section: Negative Appendectomy Ratesmentioning

confidence: 99%

“…Over the past 10 years, numerous studies have been performed to evaluate the sensitivity and specificity of CT in the diagnosis of acute appendicitis. 5 A recent systematic review showed that CT is a very accurate diagnostic tool in appendicitis, with an overall sensitivity and specificity of 94% and 95%, respectively. 6 Whereas CT is an accurate diagnostic tool in patients with suspected appendicitis, the appropriate use of CT remains controversial.…”

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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: Negative Appendectomy Ratesmentioning

confidence: 99%

mentioning

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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“…(3) The usefulness of high frequency probe and graded compression method has a high diagnostic value for acute appendicitis. (4,5) Superiority of Computed tomography compared to Ultrasonography is overemphasised by many studies (6,7,8,9,10,11) possibly because ultrasonography instrumentation was not very well developed at that time.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography Evaluation for Predominant Content of Appendix

R¹,

Adarsh²,

Kodumur³

et al. 2017

jemds

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BACKGROUNDAppendicitis is a common cause for acute abdomen. Many literatures are available on imaging appendicitis and visualisation of normal appendix, but very limited studies for predominant contents of appendix by ultrasonography. Aim-To analyse contents of appendix in normal and inflamed appendix and to find if any content has association with inflammation of appendix and severity of inflammation.

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“…A contrastação entérica por VO tem sido utilizada em alguns trabalhos (9,14,56) , porém promove retardo de pelo menos 30 minutos para a realização do exame (8,14) . Também foi demonstrado que o contraste ingerido com uma hora de antecedência alcança o ceco em apenas 50% dos casos, não sendo útil em parcela considerável de pacientes com suspeita de apendicite aguda (35,57) .…”

Section: Apendicite Agudaunclassified

Tomografia computadorizada sem contraste intravenoso no abdome agudo: quando e por que usar

Filho

Jesus²,

D'Ippólito

et al. 2006

Radiol Bras

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A tomografia computadorizada sem contraste intravenoso tem sido freqüentemente proposta na avaliação inicial de pacientes com suspeita de abdome agudo, ocupando o espaço de outros métodos diagnósticos. Os autores apresentam uma revisão bibliográfica dos principais aspectos e eficácia da tomografia computadorizada sem contraste intravenoso no diagnóstico de apendicite aguda, cólica nefrética, diverticulite, pancreatite aguda, apendicite epiplóica, pneumoperitônio e obstrução intestinal. Discutem quais as vantagens e limitações desta técnica de exame, bem como seus aspectos práticos. Unitermos: Apendicite; Diverticulite; Abdome agudo; Tomografia computadorizada; Contraste.When and why use unenhanced computed tomography in patients with acute abdomen. The use of unenhanced computed tomography has been frequently recommended for the initial assessment of patients with clinical suspicion of acute abdomen instead of other diagnostic methods. The authors present a review of the literature on the main aspects, advantages, limitations and efficacy of unenhanced computed tomography for the diagnosis of acute appendicitis, renal colic, diverticulitis, acute pancreatitis, primary epiploic appendicitis, pneumoperitoneum and small bowel obstruction. ciente com abdome agudo têm permitido difundir o seu uso, apesar do custo elevado e certa morbidade, quando comparado a outros métodos de imagem como a radiografia simples do abdome e a ultra-sonografia (US). A utilização seletiva de contraste intravenoso (IV) em exames de TC do abdome permite reduzir significativamente estes limites do método e aumentar a sua disseminação e a sua utilidade.Inúmeros relatos têm demonstrado a grande utilidade da TC abdominal sem injeção intravenosa de meio de contraste no diagnóstico de diferentes condições abdominais agudas, principalmente na identificação de apendicite aguda, diverticulite e de cálculos ureterais . É importante observar que apesar de certa controvérsia, o uso da TC de abdome sem contraste IV não exclui a possibilidade da implementação posterior da fase contrastada, sempre que considerada pertinente, garantindo-se assim a plena potencialidade do método.Mais recentemente, o uso da TC sem contraste tem sido proposto como método alternativo à radiografia simples para a avaliação inicial de pacientes com suspeita de abdome agudo, principalmente por sua elevada sensibilidade e especificidade, INTRODUÇÃOO uso da tomografia computadorizada (TC) como método de investigação do abdome representa um aprimoramento significativo no diagnóstico de diversas doenças, com conseqüente impacto nas decisões terapêuticas. Isto tem sido particularmente útil na avaliação do abdome agudo, situação na qual, para o tratamento adequado, são fundamentais a precisão e rapidez diagnósticas, fatores estes potencializados pela introdução das técnicas espiral e com multidetectores e pelo conhecimento acumulado na utilização desta ferramenta diagnóstica.Os bons resultados obtidos com a utilização da TC helicoidal no estudo do paaliada à sua rapidez e crescente dis...

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The clinical role of noncontrast helical computed tomography in the diagnosis of acute appendicitis

Cited by 77 publications

References 10 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

Ultrasonography Evaluation for Predominant Content of Appendix

Tomografia computadorizada sem contraste intravenoso no abdome agudo: quando e por que usar

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