title: Acute Appendicitis: Use of Clinical and CT Findings for Modeling Hospital Resource Utilization.
abstract: OBJECTIVE
  The purpose of this study was to retrospectively investigate associations between baseline CT findings in suspected acute appendicitis and subsequent hospital resource utilization.
  
  
  METHODS
  One hundred thirty-eight patients (76 male and 62 female patients; mean [± SD] age, 40 ± 21 years) who were admitted for suspected acute appendicitis and underwent baseline CT were included. A single radiologist reviewed CT examinations for appendiceal-related findings. Linear and logistic regressions were performed to identify independent predictors of payer and hospital resource utilization. Combined performance of identified independent factors for predicting outcomes was determined.
  
  
  RESULTS
  Greater age, lower Charlson comorbidity index (CCI), lesser appendiceal wall thickness, absence of loculated fluid collection, and absence of periappendiceal fluid were significant independent predictors of inpatient surgery (joint sensitivity, 92.7%; specificity, 65.8%). Smaller appendiceal diameter, absence of periappendiceal fluid, and laparoscopic surgery were significant independent predictors of same-day discharge (joint sensitivity, 79.1%; specificity, 64.2%). Greater CCI, greater wall thickness, and presence of periappendiceal fluid were significant independent predictors of repeat abdominopelvic CT (joint sensitivity, 82.5%; specificity, 68.1%). Presence of an appendicolith was the only significant predictor of repeat emergency department visit within 30 days (sensitivity, 61.2%; specificity, 68.8%) and the only significant predictor of repeat inpatient admission within 30 days (sensitivity, 63.6%; specificity, 68.5%). Greater appendiceal diameter and presence of free air were significant predictors of inpatient costs, and predicted costs were as follows: $8047 + ($745 × appendiceal diameter) if free air was absent; and $-39,261 + ($4426 × appendiceal diameter) if free air was present. However, costs were poorly predicted when greater than $45,000. Sex, WBC count, and payer category were not independent predictors, relative to CT findings, of any outcome.
  
  
  CONCLUSIONS
  Admission CT findings serve as independent predictors of hospital resource utilization in suspected acute appendicitis.
authors: 1 All authors: Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Ave, New York, NY 10016.|2 Present address: Department of Radiology, Duke University School of Medicine, Durham, NC.
authors: Neal K
authors: NK
authors: Viradia
authors: 1 All authors: Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Ave, New York, NY 10016.|3 Present address: Zwanger-Pesiri Radiology, Elmont, NY.
authors: Byron
authors: B
authors: Gaing
authors: 1 All authors: Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Ave, New York, NY 10016.
authors: Stella K
authors: SK
authors: Kang
authors: 1 All authors: Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Ave, New York, NY 10016.
authors: Andrew B
authors: AB
authors: Rosenkrantz
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000191:economics / Q000706:statistics & numerical data; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000191:economics / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: CT; acute appendicitis; appendectomy; cost; utilization