The Status of Appendiceal CT in an Urban Medical Center 5 Years After Its Introduction: Experience with 753 Patients

Rhea, James T.; Halpern, Elkan F.; Ptak, Thomas; Lawrason, J. Nash; Sacknoff, Richard; Novelline, Robert A.

doi:10.2214/ajr.184.6.01841802

Cited by 103 publications

(57 citation statements)

References 21 publications

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“…This lack of difference held true for all five independent readers representing various levels of experience and for all five readers averaged together. Our average sensitivity and specificity with positive oral contrast were similar to numbers reported in the literature, which reached 88-99% for sensitivity and 86-97% for specificity [1,5,19,20]. No data are available today that address sensitivity and specificity in diagnosing appendicitis with neutral oral contrast.…”

Section: Discussionsupporting

confidence: 86%

Neutralvspositive oral contrast in diagnosing acute appendicitis with contrast-enhanced CT: sensitivity, specificity, reader confidence and interpretation time

Naeger

Chang²,

Kolli³

et al. 2011

BJR

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Objective: The study compared the sensitivity, specificity, confidence and interpretation time of readers of differing experience in diagnosing acute appendicitis with contrast-enhanced CT using neutral vs positive oral contrast agents. Methods: Contrast-enhanced CT for right lower quadrant or right flank pain was performed in 200 patients with neutral and 200 with positive oral contrast including 199 with proven acute appendicitis and 201 with other diagnoses. Test set disease prevalence was 50%. Two experienced gastrointestinal radiologists, one fellow and two first-year residents blindly assessed all studies for appendicitis (2000 readings) and assigned confidence scores (15poor to 45excellent). Receiver operating characteristic (ROC) curves were generated. Total interpretation time was recorded. Each reader's interpretation with the two agents was compared using standard statistical methods. Results: Average reader sensitivity was found to be 96% (range 91-99%) with positive and 95% (89-98%) with neutral oral contrast; specificity was 96% (92-98%) and 94% (90-97%). For each reader, no statistically significant difference was found between the two agents (sensitivities p-values .0.6; specificities p-values.0.08), in the area under the ROC curve (range 0.95-0.99) or in average interpretation times. In cases without appendicitis, positive oral contrast demonstrated improved appendix identification (average 90% vs 78%) and higher confidence scores for three readers. Average interpretation times showed no statistically significant differences between the agents. Conclusion: Neutral vs positive oral contrast does not affect the accuracy of contrastenhanced CT for diagnosing acute appendicitis. Although positive oral contrast might help to identify normal appendices, we continue to use neutral oral contrast given its other potential benefits.

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Section: Discussionsupporting

confidence: 86%

Neutralvspositive oral contrast in diagnosing acute appendicitis with contrast-enhanced CT: sensitivity, specificity, reader confidence and interpretation time

Naeger

Chang²,

Kolli³

et al. 2011

BJR

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“…5,10 The quality of care in this study, using as indicators the rates of appendiceal perforation (7; 3.2%) and the rates of true negative appendectomy (5; 3.2%), was satisfactory when compared with other studies (including those that had medical imaging as their routine work-up). 1,5,16,18,19 Five of 10 negative appendicectomies were found to have other major pathology, which would still need surgery. Tw o of seven appendiceal perforations occurred during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, both medical imaging modalities were found useful in demonstrating peritoneal fluid which might explain a patient's symptoms and signs. 1,8,16,18,19,26 Subsequently, the finding might lead to diagnostic laparoscopy with clinical correlation. In addition, medical imaging has prevented 'missed appendicitis' in two equivocal presentations in this series.…”

Section: Discussionmentioning

confidence: 99%

‘To have … or not to have’. Should Computed Tomography and Ultrasonography be Implemented as a Routine Work-Up for Patients with Suspected Acute Appendicitis in a Regional Hospital?

Chiang

Tan²,

Birks

2008

annals

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This study was a retrospective audit of patients over 15 years of age who presented to the emergency department of Appendicitis is a common diagnosis, but is by no means a simple one to establish. This retrospective study investigated the value of medical imaging (ultrasonography and/or computed tomography [CT]) for patients with suspected appendicitis. Negative appendicectomy rate and appendiceal perforation with or without medical imaging were used as end points for this investigation.PATIENTS AND METHODS This study retrospectively reviewed all patients admitted in one district general hospital with suspected acute appendicitis. The patient cohort was identified from the Unit Registry and an International Classification of Diseasesbased Review of medical records. The medical records were analysed, and the outcome of patients were followed up. RESULTS Between 12 January 2004 to 27 May 2005, 168 patients' medical records were audited. The negative appendicitis rate was 6.7% and appendiceal perforation rate was 3.2%. Among them, only 20 in-patients (12%) had medical imaging (ultrasonography and/or CT scan) after clinical assessment for suspected acute appendicitis. Medical imaging had a 70% prediction rate for acute appendicitis, 20% false-negative rate, and 10% false-positive rate. Overall, the prediction rate for appendicitis by clinical assessment supplemented by laboratory tests and medical imaging at clinician's discretion was 93.2%.CONCLUSIONS Despite studies advocating routine use of medical imaging for patients with suspected acute appendicitis, this study showed that the clinical evaluation is still paramount to the management of patients with suspected acute appendicitis before considering medical imaging.

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“…7,8,12,17,22,26,28 Analysis of the 7 studies with a total of 950 female patients resulted in a pooled OR of 0.34 (95% CI 0.22-0.55; Fig. 7).…”

Section: Sex Subset Analysismentioning

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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The Status of Appendiceal CT in an Urban Medical Center 5 Years After Its Introduction: Experience with 753 Patients

Cited by 103 publications

References 21 publications

Neutralvspositive oral contrast in diagnosing acute appendicitis with contrast-enhanced CT: sensitivity, specificity, reader confidence and interpretation time

Neutralvspositive oral contrast in diagnosing acute appendicitis with contrast-enhanced CT: sensitivity, specificity, reader confidence and interpretation time

‘To have … or not to have’. Should Computed Tomography and Ultrasonography be Implemented as a Routine Work-Up for Patients with Suspected Acute Appendicitis in a Regional Hospital?

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

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