The CT diagnosis of acute appendicits

Wijetunga, Raj; Doust, Bruce D.; Bigg-Wither, Grant

doi:10.1016/s0887-2171(03)90007-2

Cited by 16 publications

(9 citation statements)

References 12 publications

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“…So while the hypothesis that increased CT utilization will decrease the negative appendectomy rate was rejected, it did support a selective use of CT scans in the group with intermediate suspicion (to reduce the negative appendectomy rate) and in low-suspicion patients (to correctly diagnose the patient). This concurs with findings of previous studies reported in the literature [20][21][22][23] that suggest no change in negative appendectomy rate despite the liberal use of CT scans. Ceydeli et al [42] even suggested that a CT scan is indicated only when the clinical suspicion of appendicitis is equivocal, and then only when the CT results are interpreted as either positive or negative by an experienced radiologist.…”

Section: Discussionsupporting

confidence: 93%

CT Scan in Patients with Suspected Appendicitis: Clinical Implications for the Acute Care Surgeon

Petrosyan

Estrada²,

Chan

et al. 2007

Eur Surg Res

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Objective: To determine the influence of computed tomography (CT) scans on diagnosis and management of patients with suspected appendicitis. Methods: Retrospective 2-year review of 1,630 patients with suspected appendicitis, categorized into three groups based on the likelihood (Alvarado scores) of having appendicitis. Group 1: low likelihood (Alvarado score ≤4); group 2: intermediate likelihood (Alvarado scores 5–7), and group 3: high likelihood (Alvarado score ≧ 8). CT scan utilization, hospital course, and final pathology were retrospectively reviewed. Results: More patients received a CT scan in 2006 as compared with 2005 (60 vs. 52%; p = 0.001). The overall appendectomy rate was similar between the 2 years (57% in 2005 vs. 57% in 2006; p = 0.995). The overall appendectomy rate in patients with a CT was significantly higher as compared with those without (60 vs. 53%; p = 0.002). The appendectomy rate in patients with Alvarado scores ≤4 and no CT scan was significantly lower than in those with a CT scan (12 vs. 48%; p < 0.0001). The overall negative appendectomy rate in patients with a CT scan was similar to that in those without: 31/546 (6%) vs. 23/383 (6%). Conclusions: CT scan utilization increased the appendectomy rate only in patients with a low clinical suspicion for appendicitis. Preoperative CT scans did not decrease the negative appendectomy rate.

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Section: Discussionsupporting

confidence: 93%

CT Scan in Patients with Suspected Appendicitis: Clinical Implications for the Acute Care Surgeon

Petrosyan

Estrada²,

Chan

et al. 2007

Eur Surg Res

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“…14 We believe this was a result of improved familiarity and subsequent diagnostic accuracy by our radiologists with interpreting appendiceal CT scans. The CT scan with rectal contrast only also ensured filling of the cecum, which has been shown by Wijetunga et al 15 to be beneficial in diagnosing appendicitis.…”

Section: Commentmentioning

confidence: 84%

Advantages of Focused Helical Computed Tomographic Scanning With Rectal Contrast Only vs Triple Contrast in the Diagnosis of Clinically Uncertain Acute Appendicitis

et al. 2004

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Hypothesis: Focused helical computed tomographic (CT) scanning with rectal contrast only is a superior diagnostic modality compared with the traditional triplecontrast CT scan for the diagnosis of acute appendicitis.Design: Prospective randomized analysis of both CT scan modalities.Interventions: Only patients with uncertain diagnosis of acute appendicitis were entered in the study. The patients were then randomized to undergo the traditional triple-contrast CT scan or the new focused CT scan with rectal contrast only. Surgical management included operation or observation for 23 hours.Results: Ninety-one patients participated in the study, including 52 in the triple-contrast group and 39 in the rectalcontrast group. The demographics of the triple-contrast vs the rectal-contrast groups were similar. The triplecontrast group had a sensitivity of 97%, specificity of 86%, positive predictive value of 90%, and negative predictive value of 93%. The rectal-contrast group had a sensitivity of 88%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 100%. There were 4 false-positive findings and 1 false-negative finding in the triple-contrast group compared with none in the rectalcontrast group. In the triple-contrast group, there were 13 perforated appendixes compared with 1 in the rectalcontrast group. The cost of a triple-contrast scan was $620 compared with $305 for a focused rectal-contrast scan. The negative appendectomy rate for the study was 8.0% (4 of 48 patients in the triple-contrast group vs 3 of 39 in the rectal-contrast group). Conclusions:The demographics, sensitivity, specificity, and positive and negative predictive values were comparable in both groups. The focused rectal-contrast procedure was better tolerated by patients and demonstrated decreased morbidity, delay to diagnosis, perforation rate, and negative appendectomy rate with no missed diagnosis and decreased cost. Therefore, we believe that focused helical CT scanning with rectal contrast only is a superior diagnostic modality compared with the traditional triplecontrast CT scan for the diagnosis of acute appendicitis.

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“…Children who did not respond to the initial antibiotic therapy and have an early appendectomy underwent 3 times as many CT scans. Previous studies have suggested efforts should be made to minimize CT scan evaluations because of concerns for radiation exposure [15]; this is especially true with our youngest and most susceptible patients.…”

Section: Discussionmentioning

confidence: 99%

Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences

Aprahamian

Barnhart

Bledsoe

et al. 2007

Journal of Pediatric Surgery

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The CT diagnosis of acute appendicits

Cited by 16 publications

References 12 publications

CT Scan in Patients with Suspected Appendicitis: Clinical Implications for the Acute Care Surgeon

CT Scan in Patients with Suspected Appendicitis: Clinical Implications for the Acute Care Surgeon

Advantages of Focused Helical Computed Tomographic Scanning With Rectal Contrast Only vs Triple Contrast in the Diagnosis of Clinically Uncertain Acute Appendicitis

Failure in the nonoperative management of pediatric ruptured appendicitis: predictors and consequences

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