title: The use of a computed tomography scan to rule out appendicitis in women of childbearing age is as accurate as clinical examination: a prospective randomized trial.
abstract: Diagnosing appendicitis continues to be a difficult task for clinicians. The use of routine CT scan has been advocated to improve the accuracy of diagnosing appendicitis. When compared with the use of clinical examination alone, CT scan was not significantly different with regard to making the diagnosis of appendicitis in women of childbearing age. The use of computed tomography in making the diagnosis of appendicitis has become the current standard of practice in most emergency rooms. In women of childbearing age, with possible appendicitis, we prospectively compared clinical observation alone (OBS) to appendiceal CT scan with clinical observation (CT). Ninety women (OBS: 48, CT: 42) with questionable appendicitis and an Alvarado Score ranging from two to eight were prospectively randomized. A true positive study/exam resulted in a laparotomy that revealed a lesion requiring operation (confirmed by pathology). A true negative exam/study did not require operation. Hospital stay (OBS = 1.9 +/- 1.6 vs CT = 1.3 +/- 1.4 days) and charges (OBS = $9,459 +/- 7,358 vs CT = $9,443 +/- 8,773) were similar. The OBS group had an accuracy of 93 per cent, sensitivity of 100 per cent, and a specificity of 87.5 per cent. The CT group had an accuracy of 93 per cent, sensitivity of 89.5 per cent, and specificity of 95.6 per cent. Although this study is too small to statistically establish equivalence, the data suggest that a CT scan reliably identifies women who need an operation for appendicitis and seems to be as good as clinical examination.
authors.affiliation: Department of Surgery, The University of Texas Health Science Center at San Antonio, Texas 78229, USA. Lopez@uthscsa.edu
authors.forename: Peter P
authors.initials: PP
authors.lastname: Lopez
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
authors.forename: Charles A
authors.initials: CA
authors.lastname: Popkin
authors.forename: Julie
authors.initials: J
authors.lastname: Jackowski
authors.forename: Joel E
authors.initials: JE
authors.lastname: Michalek
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012737:Sex Factors; D014057:Tomography, X-Ray Computed