title: Comparison of Imaging Strategies with Conditional versus Immediate Contrast-Enhanced Computed Tomography in Patients with Clinical Suspicion of Acute Appendicitis.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of conditional computed tomography (CT), i.e. CT when initial ultrasound findings are negative or inconclusive, and immediate CT for patients with suspected appendicitis.
  
  
  METHODS
  Data were collected within a prospective diagnostic accuracy study on imaging in adults with acute abdominal pain. All patients underwent ultrasound and CT, read by different observers who were blinded from the other modality. Only patients with clinical suspicion of appendicitis were included. An expert panel assigned a final diagnosis to each patient after 6 months of follow-up (clinical reference standard).
  
  
  RESULTS
  A total of 422 patients were included with final diagnosis appendicitis in 251 (60 %). For 199 patients (47 %), ultrasound findings were inconclusive or negative. Conditional CT imaging correctly identified 241 of 251 (96 %) appendicitis cases (95 %CI, 92 % to 98 %), versus 238 (95 %) with immediate CT (95 %CI, 91 % to 97 %). The specificity of conditional CT imaging was lower: 77 % (95 %CI, 70 % to 83 %) versus 87 % for immediate CT (95 %CI, 81 % to 91 %).
  
  
  CONCLUSIONS
  A conditional CT strategy correctly identifies as many patients with appendicitis as an immediate CT strategy, and can halve the number of CTs needed. However, conditional CT imaging results in more false positives.
  
  
  CONCLUSIONS
  • Conditional CT (CT after negative/inconclusive ultrasound findings) can be used for suspected appendicitis. • Half the number of CT examinations is needed with a conditional strategy. • Conditional CT correctly identifies as many patients with appendicitis as immediate CT. • Conditional imaging results in more false positive appendicitis cases.
authors.affiliation: Department of Surgery (G4-142), Academic Medical Centre, 1105 AZ, Amsterdam, Netherlands, j.j.atema@amc.nl.
authors.forename: J J
authors.initials: JJ
authors.lastname: Atema
authors.forename: S L
authors.initials: SL
authors.lastname: Gans
authors.forename: A
authors.initials: A
authors.lastname: Van Randen
authors.forename: W
authors.initials: W
authors.lastname: Laméris
authors.forename: H W
authors.initials: HW
authors.lastname: van Es
authors.forename: J P M
authors.initials: JP
authors.lastname: van Heesewijk
authors.forename: B
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: W H
authors.initials: WH
authors.lastname: Bouma
authors.forename: W
authors.initials: W
authors.lastname: Ten Hove
authors.forename: E M
authors.initials: EM
authors.lastname: van Keulen
authors.forename: M G W
authors.initials: MG
authors.lastname: Dijkgraaf
authors.forename: P M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: J
authors.initials: J
authors.lastname: Stoker
authors.forename: M A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001064:Appendicitis / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media