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

Abstract

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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