Evaluation for suspected acute appendicitis in the emergency department setting: a comparison of outcomes among three imaging pathways.
OBJECTIVE
To compare outcomes of imaging pathways in suspected acute appendicitis.


METHODS
Computerized tomography (CT) alone, ultrasound alone, and ultrasound followed by CT were compared in 570 emergency department (ED) patients with suspected acute appendicitis.


RESULTS
After initial ultrasound, 9.3% of men and 41.0% of women underwent CT. Body mass index (BMI) (P≤.036): 25.3±5.7kg/m(2) (CT), 19.1±3.3kg/m(2) (ultrasound), and 22.4±3.2kg/m(2) (ultrasound then CT). Age (P<.001): 35.9±14.5 years (CT), 12.8±6.2y (ultrasound), and 21.2±9.0 years (ultrasound then CT). ED length-of-stay: 7.0±2.8h (CT), 5.9±2.8h (ultrasound), and 8.4±3.5h (ultrasound then CT). Admission, same-day discharge, appendectomy, pathology positive for appendicitis or complicated appendicitis, 30-day repeat ED visit/hospitalization: no difference between pathways (P=.062-1.00).


CONCLUSIONS
Ultrasound, selected in patients with lowest age/BMI, had shortest length-of-stay but otherwise similar outcomes.
Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016. Electronic address: Andrew.osenkrantz@nyumc.org.
Andrew B
AB
Rosenkrantz
Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016. Electronic address: anthonylabib@gmail.com.
Anthony
A
Labib
Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016. Electronic address: Luke.Ginocchio@med.nyu.edu.
Luke A
LA
Ginocchio
Department of Radiology, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016. Electronic address: James.babb@nyumc.org.
James S
JS
Babb
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D001065:Appendix / Q000000981:diagnostic imaging; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
Acute appendicitis; CT; Emergency radiology; Outcomes; Ultrasound