Is there a role for abdominal computed tomographic scans in appendicitis?
OBJECTIVE
To better define the effectiveness of abdominal computed tomographic scanning (ACTS) in adult patients with suspected appendicitis.


METHODS
Retrospective analysis.


METHODS
A community teaching hospital.


METHODS
Ninety-seven patients with appendicitis in the differential diagnosis, whose clinical findings were insufficient to perform surgery or to discharge from the hospital, during a 14-month period.


METHODS
None.


METHODS
Accuracy of ACTS, rate of appendectomies that show no appendicitis (negative appendectomy rate), and frequency of ACTS as a definitive diagnostic test.


RESULTS
Forty-nine of the 50 patients with appendicitis were correctly diagnosed by ACTS. Forty-three of the 47 patients without appendicitis were correctly diagnosed by ACTS. Positive predictive value was 92%, negative predictive value was 98%, and accuracy was 96%. The ACTS group had a negative appendectomy rate of 5.8% (3/52), lower than the hospital rate of 14% for the preceding 3 years. The ACTS established an alternative diagnosis in 16 patients, allowed 10 other patients to be discharged early or not admitted, and was the critical diagnostic test in 30 of the patients with appendicitis. Therefore, the ACTS played a definitive role in the treatment of 56 (57.7%) of the 97 patients.


CONCLUSIONS
The ACTS was an accurate test in the diagnosis of appendicitis and was of significant benefit in 57.7% of the patients studied. However, it was difficult to predict which patients were most likely to benefit. Expanded selective use of ACTS for patients with clinically indeterminate appendicitis may result in a lower negative appendectomy rate and fewer patient admissions for observation.
Schuler
J G
JG
Department of Surgery, Mount Auburn Hospital, Cambridge, Mass 02238, USA.
Shortsleeve
M J
MJ
Goldenson
R S
RS
Perez-Rossello
J M
JM
Perlmutter
R A
RA
Thorsen
A
A
D000208:Acute Disease; D000328:Adult; D001062:Appendectomy / Q000191:economics / Q000706:statistics & numerical data; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data