title: Diagnosing acute appendicitis: surgery or imaging?
abstract: OBJECTIVE
  Investigation of suspected appendicitis varies widely across different countries, which creates variation in outcome for patients. Use of imaging drives much of this variation, with concerns over delay of imaging and radiation exposure of computed tomography being balanced against the risks of unnecessary surgery.
  
  
  METHODS
  Two national, prospective snapshot audits (UK n = 3326 and Netherlands n = 1934) reported investigation, management and outcome of appendicectomy and can be compared to generate treatment recommendations.
  
  
  RESULTS
  Preoperative imaging was conducted in 32.8% of UK patients in contrast to 99.5% of patients in the Netherlands. A large difference in the normal appendicectomy rate was observed (20.6% in the UK vs 3.2% in the Netherlands) and the connection between these two outcome differences cannot be neglected.
  
  
  CONCLUSIONS
  This article discusses the role of imaging in the diagnostic work-up of patients who are suspected of acute appendicitis, comparing national snapshot studies as a model to do so.
authors.affiliation: Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands.
authors.forename: C C
authors.initials: CC
authors.lastname: van Rossem
authors.affiliation: Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands.
authors.forename: M D M
authors.initials: MD
authors.lastname: Bolmers
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M H F
authors.initials: MH
authors.lastname: Schreinemacher
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.affiliation: Department of Surgery, Tergooi Hospital, Hilversum, The Netherlands.
authors.forename: A A W
authors.initials: AA
authors.lastname: van Geloven
authors.affiliation: Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: T D
authors.initials: TD
authors.lastname: Pinkney
authors.affiliation: Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Bhangu
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy / Q000379:methods / Q000706:statistics & numerical data*; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*; D006113:United Kingdom; D019564:Unnecessary Procedures / Q000379:methods / Q000706:statistics & numerical data*; D055815:Young Adult