Open AccessRoutine Ultrasound and Limited Computed Tomography for the Diagnosis of Acute Appendicitis
Author(s) -
Toorenvliet Boudewijn R.,
Wiersma Fraukje,
Bakker Rutger F. R.,
Merkus Jos W. S.,
Breslau Paul J.,
Hamming Jaap F.
Publication year - 2010
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-010-0694-y
Subject(s) - medicine , radiology , appendicitis , radiological weapon , perforation , abdominal pain , emergency department , ultrasound , acute appendicitis , appendix , prospective cohort study , computed tomography , interventional radiology , general surgery , surgery , paleontology , materials science , psychiatry , biology , metallurgy , punching
Background Acute appendicitis continues to be a challenging diagnosis. Preoperative radiological imaging using ultrasound (US) or computed tomography (CT) has gained popularity as it may offer a more accurate diagnosis than classic clinical evaluation. The optimal implementation of these diagnostic modalities has yet to be established. The aim of the present study was to investigate a diagnostic pathway that uses routine US, limited CT, and clinical re‐evaluation for patients with acute appendicitis. Methods A prospective analysis was performed of all patients presenting with acute abdominal pain at the emergency department from June 2005 until July 2006 using a structured diagnosis and management flowchart. Daily practice was mimicked, while ensuring a valid assessment of clinical and radiological diagnostic accuracies and the effect they had on patient management. Results A total of 802 patients were included in this analysis. Additional radiological imaging was performed in 96.3% of patients with suspected appendicitis ( n = 164). Use of CT was kept to a minimum (17.9%), with a US:CT ratio of approximately 6:1. Positive and negative predictive values for the clinical diagnosis of appendicitis were 63 and 98%, respectively; for US 94 and 97%, respectively; and for CT 100 and 100%, respectively. The negative appendicitis rate was 3.3%, the perforation rate was 23.5%, and the missed perforated appendicitis rate was 3.4%. No (diagnostic) laparoscopies were performed. Conclusions A diagnostic pathway using routine US, limited CT, and clinical re‐evaluation for patients with acute abdominal pain can provide excellent results for the diagnosis and treatment of appendicitis.