title: Prospective evaluation of the added value of imaging within the Dutch National Diagnostic Appendicitis Guideline--do we forget our clinical eye?
abstract: BACKGROUND
  Annually 16,000 appendectomies are performed in the Netherlands, of which 15-20% are negative. In 2010, to reduce this unacceptable percentage of superfluous appendectomies, the Dutch Association for Surgery introduced the 'Appendicitis Guideline'. This guideline recommends the use of imaging. In this observational prospective study the added value of imaging in everyday clinical practice is evaluated.
  
  
  METHODS
  All patients with suspected appendicitis were included at the emergency department of a Dutch teaching hospital during the period from September 2011 to May 2012 (n = 350; 237 adults and 113 children under 18 years). Adherence to the guideline was evaluated.
  
  
  RESULTS
  75 Patients (21%) were not referred for imaging because of a low suspicion or alternative diagnosis. In 16 patients (5%) the guideline was not followed. Of the 259 patients (74%) who underwent ultrasonography, 105 (30%) also underwent computed tomography (CT). 127 appendectomies were performed, showing appendicitis in 112 patients (88%); 15 appendectomies (12%) were negative. In the latter group, 12 were performed after false positive imaging results, and 3 following inconclusive imaging results.
  
  
  CONCLUSIONS
  When using imaging in the diagnosis of appendicitis, the percentage of negative appendectomies remains close to the percentage declared as unacceptable by the publishers of the guideline.
authors.affiliation: Department of Surgery, VieCuri Medical Centre, Venlo, The Netherlands.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schok
authors.forename: Petra C G
authors.initials: PC
authors.lastname: Simons
authors.forename: Maryska L G
authors.initials: ML
authors.lastname: Janssen-Heijnen
authors.forename: Nathalie A L R
authors.initials: NA
authors.lastname: Peters
authors.forename: Joop L M
authors.initials: JL
authors.lastname: Konsten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D019564:Unnecessary Procedures; D055815:Young Adult