Original Article

An Outcome Study of the Use of Computed Tomography for the Diagnosis of Appendicitis in a Community-based Emergency Department

Authors: Robert D. Mathis, MD, Andrea B. Chiumento, MD, MS, Benson Yeh, MD, Nita Dollieslager, RN


Objectives: Previous studies evaluating the use of CT in the diagnosis of appendicitis have taken place at university-based institutions where surgical bedside consultation seems prudent before radiological study. In the private hospital setting, the emergency department (ED) physician is responsible for diagnosis. We attempt to assess if this process is detrimental to patient care.

Methods: Retrospective review of 150 patient’s records admitted through the ED was performed with the discharge diagnosis of appendicitis between March 1998 and May 2000. Data was stratified for analysis based on age (< 15, 15–50, > 50) and gender. Using Graph Pad Prism software the groups were compared for complications based on whether or not CT was obtained. Chi-square, number needed to treat (NNT), absolute risk reduction (ARR), relative risk reduction (RRR) and respective confidence intervals were calculated for each group.

Results: No significant differences overall were obtained between CT and no CT groups at P < 0.05. A significant benefit is demonstrated at P = 0.017 in females of childbearing age while a detrimental trend is found for those over the age of 50 years.

Conclusions: Contrary to our initial hypothesis, no increased incidence of appendiceal perforation or abscess was demonstrated based on the ED physician’s decision to perform CT without surgical consultation.

Key Points

* In the community hospital setting, bedside surgical consultation is not always available and the decision to utilize CT evaluation for the diagnosis of appendicitis becomes the responsibility of the ED physician.

* CT evaluation of the patient presenting emergently with abdominal pain has its greatest utility for those with atypical symptoms, age of presentation, and female gender.

* Perceived delays in the diagnosis of appendicitis utilizing CT imaging are not detrimental to patients presenting emergently in the community hospital-based setting.

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1.Rao PM, Rhea JT, Novelline RA, et al. Helical CT technique for the diagnosis of Appendicitis: Prospective evaluation of a focused appendix CT examination. Radiology 1997;202:139–144.
2.Rao PM, Rhea JT, Novelline RA, et al. Effects of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 1998;338:141–146.
3.Funaki B, Grosskreutz SR, Funaki CN. Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR 1998;171:997–1001.
4.Paulson EK, Kalady MF, Pappas TN. Suspected appendicitis. N Engl J Med 2003;348:236–242.
5.Malone AJ, Wolf CR, Malmed AS, et al. Diagnosis of acute appendicitis: Value of unenhanced CT.AJR 1993;160:763–766.
6.Birnbaum BA, Jeffrey RB. CT and sonographic evaluation of acute right lower quadrant abdominal pain. AJR 1998;170:361–371.
7.Balthazar EJ, Megibow AJ, Siegel SE, et al. Appendicitis: Prospective evaluation with high-resolution CT. Radiology 1991;180:21–24.
8.Neumayer L, Wako E, Fergestaad J, et al. Impact of journal articles and grand rounds on practice: CT scanning in appendicitis. J Gastrointest Surg 2002;6:338–341.
9.Morris KT, Kavanagh M, Hansen P, et al. The rational use of computed tomography scans in the diagnosis of appendicitis. Am J Surg 2002;183:547–550.
10.Raptopoulos V, Katsou G, Rosen MP, et al. Acute Appendicitis: Effect of increasing use of CT on selecting patients earlier. Radiology 2003;226:521–526.
11.Fuchs JR, Schlamberg JS, Shortsleeve MJ, et al. Impact of abdominal CT imaging on the management of appendicitis: An update. J Surg Res 2002;106:131–136.
12.Balthazar EJ, Rofsky NM, Zucker R. Appendicitis: The impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol 1998;93:768–771.
13.Stroman DL, Bayouth CV, Kuhn JA, et al. The role of computed tomography in the diagnosis of acute appendicitis. Am J Surg 1999;178:485–489.
14.Balthazar EJ, Birnbaum BA, Yee J, et al. Acute appendicitis: CT and US correlation in 100 patients.Radiology 1994;190:31–35.
15.Johnson D, editor. World literature review: Diagnosis of acute right lower quadrant pain and appendicitis by CT scan: Do we still need the clinician? Am J Gastroenterol 2000;95:1355-1357.
16.Safran DB, Pilati D, Folz E, et al. Is appendiceal CT scan overused for evaluating patients with right lower quadrant pain? Am J Emerg Med 2001;19:199-203.
17.McDonough J, Stasik C, Piontkowsky D, et al. Can appendiceal CT scanning be utilized effectively in widespread general surgical practice? Am Surg 2002;68:917–921.
18.Weyant MJ, Eachempati SR, Maluccio MA, et al. The use of computed tomography for the diagnosis of acute appendicitis in children does not influence the overall rate of negative appendectomy or perforation. Surg Infect 2001;2:19–23.
19.Karakas SP, Guelfquat M, Leonidas JC, et al. Acute appendicitis in children: Comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol 2000;30:94–98.
20.Flum DR, Morris A, Koepsell T, et al. Has misdiagnosis of appendicitis decreased over time? JAMA2001;286:1748–1753.
21.McDonald GP, Pendarvis DP, Wilmoth R, et al. Influence of preoperative computed tomography on patients undergoing appendectomy. Am Surg 2001;67:1017–1021.
22.Perez J, Barone JE, Wilbanks TO, et al. Liberal use of computed tomography scanning does not improve diagnostic accuracy in appendicitis. Am J Surg 2003;185:194–197.
23.Lee SL, Walsh AJ, Ho HS. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Arch Surg 2001;136:556–562.
24.Lewis FR, Holcroft JW, Boey J, et al. Appendicitis: A critical review of diagnosis and treatment in 1000 cases. Arch Surg 1975;110:677–681.
25.Bendeck SE, Nino-Murcia M, Berry GJ, et al. Imaging for suspected appendicitis: Negative appendectomy and perforation rates. Radiology 2002;225:131–136.
26.Naoum JJ, Mileski WJ, Daller JA, et al. The use of abdominal computed tomography scan decreases the frequency of misdiagnosis in cases of suspected appendicitis. Am J Surg 2002;184:587–589.