How Often does Computed Tomography Change the Management of Acute Appendicitis?

2009 ◽  
Vol 75 (10) ◽  
pp. 918-921 ◽  
Author(s):  
David A. Santos ◽  
Jesse Manunga ◽  
Donald Hohman ◽  
Elisa Avik ◽  
Edward W. Taylor
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Operative Management ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Interval Appendectomy ◽  
Negative Appendectomy Rate

Computed tomography (CT) diagnoses appendicitis accurately, but few studies evaluate how often CT changes the management of appendicitis. Consultations for appendicitis were evaluated by surgeons and assigned to groups: high, indeterminate, and low suspicion. After assignment, CT was reviewed if completed or ordered if desired by the surgeon and changes in plans were noted. One hundred patients were evaluated for appendicitis, 70 received appendectomy. Our negative appendectomy rate was 4 of 70 (5.7%). In the high suspicion group, 63 patients had 23 CT scans performed and 2 CT scans were negative, avoiding unnecessary operation and changing management in 2 of 63 (3.2%). The intermediate suspicion group included 27 patients and 26 CT scans performed; 11 were positive resulting in nine positive appendectomies and changing management in 9 of 27 (33%). The low suspicion group had 7 CT scans performed; two were positive leading to two positive appendectomies and changing management in 2 of 10 (20%). CT promoted 10 of 100 patients to the interval appendectomy pathway with no failures in delayed operative management. CT rarely changes management in patients highly suspicious for appendicitis, but may have a role in selecting patients for interval appendectomy. CT frequently changes management if the clinical diagnosis is indeterminate.

scholarly journals Conditional CT Strategy—An Effective Tool to Reduce Negative Appendectomy Rate and the Overuse of the CT

2021 ◽  
Vol 10 (11) ◽  
pp. 2456
Author(s):  
Raminta Luksaite-Lukste ◽  
Ruta Kliokyte ◽  
Arturas Samuilis ◽  
Eugenijus Jasiunas ◽  
Martynas Luksta ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Sensitivity And Specificity ◽  
Surgical Outcomes ◽  
Imaging Modality ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Transabdominal Ultrasound ◽  
First Choice ◽  
Negative Appendectomy Rate

(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.

Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast?

2008 ◽  
Vol 74 (10) ◽  
pp. 917-920 ◽  
Author(s):  
Daniel D. Dearing ◽  
Jamesa Recabaren ◽  
Magdi Alexander
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Ct Scanning ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Suspected Appendicitis ◽  
Ct Examination ◽  
Preoperative Ct ◽  
Negative Appendectomy Rate ◽  
Pathology Reports

The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

scholarly journals A study to find out correlation between clinical diagnosis and histopathological diagnosis in patients with acute appendicitis undergoing surgical treatment

2019 ◽  
Vol 6 (6) ◽  
pp. 2046
Author(s):  
Mohit Jain ◽  
Yogesh Kumar Sharma
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Scoring System ◽  
Emergency Operation ◽  
Negative Appendectomy ◽  
Histopathological Diagnosis ◽  
Complication Rates ◽  
Diagnostic Modality ◽  
Negative Appendectomy Rate ◽  
A Prospective Study

Background: Acute appendicitis is one of the most frequent abdominal emergencies and appendectomy subsequently the most common emergency operation performed all over the world. The aim of the study is to evaluate the reliability of Clinical Diagnosis for diagnosis of acute appendicitis and correlate it with the gold standard and absolute diagnostic modality, histopathology.Methods: This is a prospective study carried out in 150 patients who were admitted under department of surgery, AFMC Pune, Maharashtra from 1st July 2014 to 31st June 2016 for a clinical diagnosis of acute appendicitis.Results: In our study overall negative appendectomy rate was 18.7% (12.37% in male and 30.19% in female). Hence in the overall females had more negative appendectomy rate compared to males. In our series a score of >7 using Alvarado system had a total sensitivity of 72.95%. While sensitivity increases to 99.18% when score of >5 used as cut-off.Conclusions:Alvarado scoring system is beneficial in decreasing negative appendectomy rate and thus reduces complication rates. It is effective in the diagnosis of acute appendicitis in both men and females but some other diagnostic modality may be necessary to ascertain the diagnosis in females along with the clinical scoring system to rule out other pelvic pathology and to reduce negative appendectomy rate in females. 

scholarly journals Acute Appendicitis in Children: Comparison of clinical diagnosis versus modified Alvarado score system

2016 ◽  
Vol 10 (1) ◽  
Author(s):  
Mukhtar Hussain ◽  
Muhammad Kashif ◽  
Shafiq Ahmad ◽  
Haroon Khurshid Pasha
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
False Positive ◽  
Negative Appendectomy ◽  
Alvarado Score ◽  
Score System ◽  
Pain Abdomen ◽  
Group I ◽  
Negative Appendectomy Rate ◽  
Modified Alvarado Score

Objective: To compare the accuracy of clinical diagnosis of Acute Appendicitis with that of Alvarado Score System in Children. Design: A Prospective and Comparative Study. Patients and Duration of Study: Department of Pediatric Surgery, Nishtar Medical College & Hospital, Multan from January 200I to June 2002. All patients of pain abdomen with suspicion of acute appendicitis were included in study. Subjects and methods: 92 patients were admitted with pain abdomen, After preliminary history and examination sixty were suspected of acute appendicitis. A Detailed history, clinical examination and relevant investigations were done. These patients were divided in two equal groups of 30 each. In group-I all the findings were entered on Performa based on the indicants of modified Alvarado Score. Later on their Score was calculated according to the assigned weight-age of each indicant. Twenty-eight patients were submitted for Surgery having Alvarado Score of >7. In group-II patients were clinically evaluated by one of the consultant to declare the diagnosis of Acute Appendicitis or otherwise. Twenty-nine out of 30 were submitted for surgery in this group. Three cases turned out to be of mesenteric lymphadenitis confirmed on Ultrasonography. The diagnosis of Acute Appendicitis was further confirmed by Histopathology of appendix after removal. Hence the accuracy of both methods was compared. Results: The diagnostic accuracy of Alvarado Score was 85.71% with false positive or negative appendectomy rate of 14.29% while the accuracy of clinical diagnosis was 93.01% with false positive or negative appendectomy rate of 6.99%.

Negative Appendectomy Rate: Influence of CT Scans

2005 ◽  
Vol 71 (10) ◽  
pp. 803-808 ◽  
Author(s):  
Marcial Mcgory ◽  
Davids Zingmond ◽  
Darshani Nanayakkara ◽  
Melinda A. Maggard ◽  
Clifford Y. Ko
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Patient Age ◽  
Entire Cohort ◽  
Patient Âgé ◽  
Negative Appendectomy Rate ◽  
The Impact ◽  
Age And Sex

Negative appendectomy rate varies significantly depending on patient age and sex. However, the impact of computed tomography (CT) scans on the diagnosis of appendicitis is unknown. The goal of this study was to examine the negative appendectomy rate using a statewide database and analyze the association of receipt of CT scan. Using the California Inpatient File, all patients undergoing appendectomy in 1999–2000 were identified (n = 75,452). Demographic and clinical data were analyzed, including procedure approach (open vs laparoscopic) and appendicitis type (negative, simple, abscess, peritonitis). Patients with CT scans performed were identified to compare the negative appendectomy rate. For the entire cohort, appendicitis type was 59 per cent simple, 10 per cent with abscess, 18.7 per cent with peritonitis, and 9.3 per cent negative. Males had a lower rate of negative appendicitis than females (6.0% vs 13.4%, P < 0.0001). The use of CT scans was associated with an overall lower negative appendectomy rate for females, especially in the <5 years and >45 years age categories. Use of CT scans in males does not appear to be efficacious, as the negative appendectomy rates were similar across all age categories. In conclusion, use of CT was associated with lower rate of negative appendectomy, depending on patient age and sex.

Accuracies of Diagnostic Methods for Acute Appendicitis

2013 ◽  
Vol 79 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Jong Seob Park ◽  
Jin Ho Jeong ◽  
Jong In Lee ◽  
Jong Hoon Lee ◽  
Jea Kun Park ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Physical Examination ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Negative Appendectomy ◽  
Pathologic Findings ◽  
Negative Appendectomy Rate ◽  
Sensitivity Specificity

The objectives were to evaluate the effectiveness of ultrasonography, computed tomography, and physical examination for diagnosing acute appendicitis with analyzing their accuracies and negative appendectomy rates in a clinical rather than research setting. A total of 2763 subjects were enrolled. Sensitivity, specificity, positive predictive value, and negative predictive value and negative appendectomy rate for ultrasonography, computed tomography, and physical examination were calculated. Confirmed positive acute appendicitis was defined based on pathologic findings, and confirmed negative acute appendicitis was defined by pathologic findings as well as on clinical follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasonography were 99.1, 91.7, 96.5, and 97.7 per cent, respectively; for computed tomography, 96.4, 95.4, 95.6, and 96.3 per cent, respectively; and for physical examination, 99.0, 76.1, 88.1, and 97.6 per cent, respectively. The negative appendectomy rate was 5.8 per cent (5.2% in the ultrasonography group, 4.3% in the computed tomography group, and 12.2% in the physical examination group). Ultrasonography/computed tomography should be performed routinely for diagnosis of acute appendicitis. However, in view of its advantages, ultrasonography should be performed first. Also, if the result of a physical examination is negative, imaging studies after physical examination can be unnecessary.

EP.FRI.479 Clinical accuracy of u/sound combined with inflammatory markers in Acute Appendicitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nadia Gulnaz ◽  
Sadia Tasleem ◽  
Farooq Abdullah
Keyword(s):  
Acute Appendicitis ◽  
Clinical Diagnosis ◽  
Inflammatory Markers ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Negative Appendectomy ◽  
Care Hospital ◽  
Clinical Accuracy ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity

Abstract Traditionally acute appendicitis has been a clinical diagnosis based on patients' history and physical examination, but the accuracy of clinical diagnosis ranges from 70-95%. Pre-operative diagnosis of acute appendicitis still remains an enigmatic challenge, because no single test alone can reduce the rate of negative appendectomy. Hence some authors have recommended a combination of two or more investigations to increase accuracy and therefore the use of imaging is gaining support. The objective of the study was to determine the clinical accuracy of ultrasound, combined with inflammatory markers such as CRP, WBC, and neutrophilia keeping histopathology as the gold standard. Methods The study was conducted in a Tertiary care hospital in Peshawar from September 2014 to March 2015 on 250 patients who were clinically diagnosed with acute appendicitis. All these patients underwent u/sound scanning in addition to blood tests. Findings In this study, WBC had the highest sensitivity (77.68%) followed by neutrophil% (69.96%), CRP(67.10%), and U/Sound (62.96%) respectively. While U/Sound had the highest specificity (70.59%) followed by CRP and TLC (64.71% each) and neutrophil% (58.82%) respectively. When all the four tests were combined the sensitivity, specificity, (99.17% and 98.45%) increased significantly. When all four tests were negative, appendicitis could be safely ruled out. Conclusion Acute appendicitis is very unlikely and surgery can be safely deferred in these patients when all tests are negative thereby reducing the negative appendicectomy rates. 

Abdominal Computed Tomography in the Evaluation of Acute and Perforated Appendicitis in the Community Setting

2007 ◽  
Vol 73 (10) ◽  
pp. 1002-1005 ◽  
Author(s):  
D.O. Vu Huynh ◽  
Fariborz Lalezarzadeh ◽  
Shokry Lawandy ◽  
David T. Wong ◽  
Victor C. Joe
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Predictive Value ◽  
Perforated Appendicitis ◽  
Community Setting ◽  
Diagnostic Value ◽  
Academic Community ◽  
Negative Appendectomy ◽  
Community Based ◽  
Abdominal Computed Tomography

Several studies report sensitivity and specificity of abdominal computed tomography scans (CT) for the evaluation of acute appendicitis as high as 98 per cent. Despite increased utilization of CT, the rate of negative appendectomy has remained constant at 10 to 20 per cent. The objective of this study was to assess the effectiveness of CT in the evaluation of acute and perforated appendicitis in an academic community-based setting. A retrospective review of 550 patient charts with International Classification of Diseases-9 (ICD-9) codes for acute and perforated appendicitis from January 2002 to October 2005 was performed. Sensitivity of CT was 87 per cent with a positive predictive value of 92 per cent. Specificity was 42 per cent with a negative predictive value of 29 per cent. Negative appendectomy rates were similar with or without CT (11% vs 13%, respectively). Our data suggests that CT used liberally in everyday practice in a community-based setting to evaluate acute appendicitis may not have as strong of a diagnostic value as those used in protocol-driven research studies. Further prospective studies are needed to formulate criteria to better delineate the role of CT in the evaluation of acute appendicitis.

scholarly journals Comparing the efficacy of clinical diagnosis and computed tomography in the diagnosis of acute appendicitis

2013 ◽  
Vol 11 (8) ◽  
pp. 652-653
Author(s):  
Rishi Mandavia ◽  
Maartje Ament ◽  
Dawit Worku ◽  
Hemant Sheth
Keyword(s):  
Computed Tomography ◽  
Acute Appendicitis ◽  
Clinical Diagnosis
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