Diagnosing acute appendicitis: are we overusing radiologic investigations?
OBJECTIVE
Acute appendicitis is the most common emergency presenting to pediatric surgeons. With proper history and thorough physical examination, the diagnosis of the condition clinically should approach 90%. With the increasing ease of performing radiologic investigations because of technological advances, more ultrasound and computed tomography (CT) are used to help diagnosing appendicitis. The aim of this study is to review the trend of diagnosing appendicitis in a single center and discuss the implications.


METHODS
A retrospective analysis was carried out for all patients who were admitted with acute appendicitis between 1997 and 2007. The methods of diagnosis were divided into 3 groups as follows: clinical, ultrasound, and CT. The demographics and operative findings were noted. Statistical analysis was done using Fisher's Exact test and paired t test when appropriate. A value of P < .05 was considered to be statistically significant.


RESULTS
During this period, a total of 254 patients (167 boys and 87 girls) were admitted with appendicitis. The average age at presentation was 12 years, and the mean duration of symptoms before presentation was 2 days. For 11 years, there was an initial rise of the use of ultrasound (10% in 1997 to a peak of 60% in 2005). This percentage decreased with a corresponding rise of the use of CT scan (0% in 1997 to 35% in 2007). There was no correlation found between the use of adjunct investigations and the severity of appendicitis found at operation, suggesting an overreliance of CT.


CONCLUSIONS
It appears that there is an increasing trend in using radiologic investigations for the diagnosis of appendicitis for the past 11 years. With the association of cancer in later life and early radiation exposure well documented, it would be advisable to avoid the use of CT if possible.
Wong
Kenneth K Y
KK
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China. kkywong@hkucc.hku.hk
Cheung
Tammy W Y
TW
Tam
Paul K H
PK
D000208:Acute Disease; D000293:Adolescent; D001062:Appendectomy; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007416:Intestinal Perforation / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D010808:Physical Examination; D011832:Radiation Injuries / Q000517:prevention & control; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000706:statistics & numerical data*; D014463:Ultrasonography