title: Appendicitis-the balance between cost effectiveness and safety remains challenging.
abstract: OBJECTIVE
  The diagnosis of acute appendicitis remains a challenge in daily clinical practice. The aim of the present study was to determine clinical criteria for a careful and cost-effective integration of computed tomography (CT) scans in the clinical pathway for the diagnosis of acute appendicitis.
  
  
  METHODS
  In this retrospective study, we analyzed all patients who were admitted to our hospital with suspected appendicitis (2008-2011). We included all patients who had an appendectomy with or without preoperative CT. Furthermore, we analyzed all patients who received a CT because of suspected appendicitis but did not have an appendectomy.
  
  
  RESULTS
  A total of 367 patients were included in this study. A CT was performed in 35 % of the patients with suspected appendicitis. Women had a significantly higher rate of negative appendectomy (NA) (16.5 %) than men (5.3 %). The frequency of NA was 5.7 % in the group of patients who were imaged, whereas it was 11.8 % (p = 0.075) among those who were not imaged. Thereby, CT scans helped to reduce total hospital expenses (<euro>1,317.44 (no CT scan) to <euro>675.85 (CT scan and no operation). Furthermore, CT scans can be avoided in men with normal white blood cell counts who should be observed if not operated immediately.
  
  
  CONCLUSIONS
  CT can be effectively applied for the diagnosis of acute appendicitis. We propose a diagnostic algorithm which helps to simultaneously avoid unnecessary operations and radiation exposure.
authors.affiliation: Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe-University, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany, juliane.liese@kgu.de.
authors.forename: Juliane
authors.initials: J
authors.lastname: Liese
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Halbinger
authors.forename: Frank
authors.initials: F
authors.lastname: Ulrich
authors.forename: Wolf O
authors.initials: WO
authors.lastname: Bechstein
authors.forename: Christoph W
authors.initials: CW
authors.lastname: Strey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000191:economics*; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics*; D019564:Unnecessary Procedures / Q000191:economics