The role of computed tomography in the diagnosis of acute appendicitis

Stroman, David; Bayouth, Charles V; Kuhn, Joseph A.; Westmoreland, Matthew V.; Jones, Ronald C.; Fisher, Tammy; McCarty, Todd M.

doi:10.1016/s0002-9610(99)00223-8

Cited by 125 publications

(86 citation statements)

References 10 publications

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“…Twelve studies were case series without a control group. 30,[34][35][36][37][38][39][40][41][42][43][44] Three articles were reviews without any primary clinical data. 2,45,46 One article evaluated the clinical outcomes before and after the implementation of an ED protocol, but both arms of the study had identical rates of CT investigation.…”

Section: Excluded Studiesmentioning

confidence: 99%

Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis

Krajewski

2011

Can J Surg

135

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RESEARCH • RECHERCHEImpact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis Background: Clinical evaluation alone is still considered adequate by many clinicians who treat patients with appendicitis. The impact of computed tomography (CT) on clinical outcomes remains unclear, and there is no consensus regarding the appropriate use of CT in these patients. We sought to evaluate the impact of abdominal CT on the clinical outcomes of patients presenting with suspected appendicitis. Methods:We conducted a systematic review of the literature to identify studies that examined clinical outcomes related to the use of abdominal CT in the diagnosis of acute appendicitis. Inclusion criteria were studies of adult patients with suspected appendicitis that evaluated the impact of abdominal CT on negative appendectomy rates, perforation rates or time to surgery. Two independent investigators reviewed all titles and abstracts and extracted data from 28 full-text articles. Statistical analysis was conducted using Review Manager 5.0.10 software. Results:The negative appendectomy rate was 8.7% when using CT compared with 16.7% when using clinical evaluation alone (p < 0.001). There was also a significantly lower negative appendectomy rate during the CT era compared with the pre-CT era (10.0% v. 21.5%, p < 0.001). Time to surgery was evaluated in 10 of the 28 studies, 5 of which demonstrated a significant increase in the time to surgery with the use of CT. Appendiceal perforation rates were unchanged by the use of CT (23.4% in the CT group v. 16.7% in the clinical evaluation group, p = 0.15). Similarly, the perforation rate during the CT era was not significantly different than that during the pre-CT era (20.0% v. 19.6%, p = 0.74). Conclusion:This meta-analysis supports the hypothesis that the use of preoperative abdominal CT is associated with lower negative appendectomy rates. The use of CT in the absence of an expedited imaging protocol may delay surgery, but this delay is not associated with increased appendiceal perforation rates. Routine CT in all patients presenting with suspected appendicitis could reduce the rate of unnecessary surgery without increasing morbidity. Contexte :Beaucoup de cliniciens qui traitent des patients atteints d'appendicite considèrent toujours que l'évaluation clinique seule suffit. L'effet de la tomodensitométrie (TDM) sur les résultats cliniques n'est toujours pas clair et il n'y a pas de consensus au sujet de l'utilisation appropriée de la TDM chez ces patients. Nous avons cherché à évaluer l'effet de la TDM abdominale sur les résultats cliniques des patients chez qui l'on soupçonne une appendicite.Méthodes : Nous avons procédé à une synthèse systématique des publications pour trouver des études où l'on examinait les résultats cliniques reliés à l'utilisation de la TDM abdominale pour diagnostiquer l'appendicite aiguë. Les études portant sur des patients adultes chez lesquels on soupçonnait une appendicite qui ont évalué l...

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Section: Excluded Studiesmentioning

confidence: 99%

Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis

Krajewski

2011

Can J Surg

135

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“…A number of researchers using contrast-enhanced CT with both IV and oral contrast materials reported that sensitivity, specificity and accuracy ranges in their diagnoses of acute appendicitis were 92-98%, 85-100%, and 90-99% respectively (13,14,18,19). Anderson et al demonstrated that, there is no significant difference for diagnosing appendicitis between oral and IV enhanced MDCT with only IV enhanced MDCT by using 64-slice MDCT (20).…”

Section: Resultsmentioning

confidence: 99%

Comparison of combined oral and iv contrast-enhanced versus single iv contrast-enhanced mdct for the detection of acute appendicitis

Hekimoğlu¹,

Yildirim²,

Karabulut³

et al. 2011

Journal of the Belgian Society of Radiology

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Objective: The aim of our study was to compare the diagnostic ability of oral added intravenous (IV) contrastenhanced multidetector computed tomography (MDCT) versus only IV contrast-enhanced MDCT in diagnosing of acute appendicitis. Materials and methods: MDCT images of 200 patients were evaluated prospectively in this study. Patients were randomized into one of two groups: Group 1 (Gp1) patients underwent 16-MDCT performed with oral and IV contrast-enhanced and Group 2 (Gp2) subjects underwent 16-MDCT with only IV contrast-enhanced protocol. Final decision was based on histopathologic operative data and follow-up of patients. Results: In Gp1, Reader1 had 96.9% and 98.5% and Reader2 had 84% and 94.7% sensitivity and specificity values respectively. For Gp2, the values for Reader1 were 81% and 94%. For Reader2 in Gp2, the values were 76% and 91%. We achieved higher sensitivity and specificity values with combined contrast administration versus only IV contrastenhanced MDCT imaging. However, there was no statistically significant differences between two readers in the AUC values of each group for the detection of acute appendicitis. Conclusion: It is statistically concluded that oral contrast do not contribute to the a better accuracy. So in the routine practice, oral contrast has not to be recommended. Key-word: Appendicitis.From: 1.

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“…(3) The usefulness of high frequency probe and graded compression method has a high diagnostic value for acute appendicitis. (4,5) Superiority of Computed tomography compared to Ultrasonography is overemphasised by many studies (6,7,8,9,10,11) possibly because ultrasonography instrumentation was not very well developed at that time.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonography Evaluation for Predominant Content of Appendix

R¹,

Adarsh²,

Kodumur³

et al. 2017

jemds

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BACKGROUNDAppendicitis is a common cause for acute abdomen. Many literatures are available on imaging appendicitis and visualisation of normal appendix, but very limited studies for predominant contents of appendix by ultrasonography. Aim-To analyse contents of appendix in normal and inflamed appendix and to find if any content has association with inflammation of appendix and severity of inflammation.

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The role of computed tomography in the diagnosis of acute appendicitis

Cited by 125 publications

References 10 publications

Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis

Impact of computed tomography of the abdomen on clinical outcomes in patients with acute right lower quadrant pain: a meta-analysis

Comparison of combined oral and iv contrast-enhanced versus single iv contrast-enhanced mdct for the detection of acute appendicitis

Ultrasonography Evaluation for Predominant Content of Appendix

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