title: ACR Appropriateness Criteria® right lower quadrant pain--suspected appendicitis.
abstract: The diagnostic imaging of patients presenting with right lower quadrant pain and suspected appendicitis may be organized according to age and gender and to the presence or absence of "classic" signs and symptoms of acute appendicitis. Among adult patients presenting with clinical signs of acute appendicitis, the sensitivity and specificity of CT are greater than those of ultrasound, with improved performance when CT is performed with intravenous contrast. The use of rectal contrast has been associated with decreased time in the emergency department. Computed tomography has also been shown to reduce cost and negative appendectomy rates. Both CT and ultrasound are also effective in the identification of causes of right lower quadrant pain unrelated to appendicitis. Among pediatric patients, the sensitivity and specificity of graded-compression ultrasound can approach those of CT, without the use of ionizing radiation. Performing MRI after inconclusive ultrasound in pregnant patients has been associated with sensitivity and specificity of 80% to 86% and 97% to 99%, respectively. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors: Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. mrosen2@bidmc.harvard.edu
authors: Max P
authors: MP
authors: Rosen
authors: Alexander
authors: A
authors: Ding
authors: Michael A
authors: MA
authors: Blake
authors: Mark E
authors: ME
authors: Baker
authors: Brooks D
authors: BD
authors: Cash
authors: Jeff L
authors: JL
authors: Fidler
authors: Thomas H
authors: TH
authors: Grant
authors: Frederick L
authors: FL
authors: Greene
authors: Bronwyn
authors: B
authors: Jones
authors: Douglas S
authors: DS
authors: Katz
authors: Tasneem
authors: T
authors: Lalani
authors: Frank H
authors: FH
authors: Miller
authors: William C
authors: WC
authors: Small
authors: Stephanie
authors: S
authors: Spottswood
authors: Gary S
authors: GS
authors: Sudakoff
authors: Mark
authors: M
authors: Tulchinsky
authors: David M
authors: DM
authors: Warshauer
authors: Judy
authors: J
authors: Yee
authors: Brian D
authors: BD
authors: Coley
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis; D015746:Abdominal Pain / Q000175:diagnosis; D001064:Appendicitis / Q000175:diagnosis*; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000009:adverse effects / Q000592:standards*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000592:standards; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D011830:Radiation Effects; D011835:Radiation Protection; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012955:Societies, Medical / Q000592:standards; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods; D018608:Ultrasonography, Doppler / Q000009:adverse effects / Q000592:standards