Introduction of appendiceal CT : Impact on negative appendectomy and appendiceal perforation rates

OBJECTIVE To evaluate the impact of appendiceal computed tomography (CT) availability on negative appendectomy and appendiceal perforation rates. Appendiceal CT is 98% accurate. However, its impact on negative appendectomy and appendiceal perforation rates has not been reported. The authors reviewed...

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Bibliographic Details
Published in:	Annals of surgery Vol. 229; no. 3; pp. 344 - 349
Main Authors:	RAO, P. M, RHEA, J. T, RATTNER, D. W, VENUS, L. G, NOVELLINE, R. A
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott 01-03-1999
Subjects:	Adolescent Adult Aged Aged, 80 and over Appendectomy - statistics & numerical data Appendicitis - diagnostic imaging Appendicitis - epidemiology Appendicitis - surgery Biological and medical sciences Child Diagnosis, Differential Digestive system False Positive Reactions Female Humans Intestinal Perforation - diagnostic imaging Intestinal Perforation - epidemiology Intestinal Perforation - surgery Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Radiodiagnosis. Nmr imagery. Nmr spectrometry Rupture, Spontaneous Tomography, X-Ray Computed Human Appendectomy Radiodiagnosis Perforation Exploration Appendix Incidence Vermiform appendix Efficiency Surgery Digestive diseases Medical imagery Intestinal disease Computerized axial tomography Diagnosis Failure
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Summary:	OBJECTIVE To evaluate the impact of appendiceal computed tomography (CT) availability on negative appendectomy and appendiceal perforation rates. Appendiceal CT is 98% accurate. However, its impact on negative appendectomy and appendiceal perforation rates has not been reported. The authors reviewed the medical records of 493 consecutive patients who underwent appendectomy between 1992 and 1995, 209 consecutive patients who underwent appendectomy in 1997 (59% of whom had appendiceal CT), and 206 patients who underwent appendiceal CT in 1997 without subsequent appendectomy. Before appendiceal CT, 98/493 patients (20%) taken to surgery had a normal appendix. After CT availability, 15/209 patients (7%) taken to surgery had a normal appendix; 7 patients did not have CT, 5 patients had surgery despite a negative CT, and 3 patients had a false-positive CT. Negative appendectomy rates were lowered overall (20% to 7%), in men (11% to 5%), in women (35% to 11%), in boys (10% to 5%), and in girls (18% to 12%). Appendiceal perforation rates dropped from 22% to 14% after CT availability. CT excluded appendicitis in 206 patients in 1997 who avoided appendectomy and identified alternative diagnoses in 105 of these patients (51%). The availability of appendiceal CT coincided with a drop in the negative appendectomy rate from 20% to 7% in all patients, and to only 3% in patients with a positive CT. Perforation rates decreased from 22% to 14%. Appendiceal CT can be advocated in nearly all female and many male patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0003-4932 1528-1140
DOI:	10.1097/00000658-199903000-00007