TY  - JOUR
T1  - IS there a role for abdominal computed tomographic scans in appendicitis?
AU  - Schuler JG, Shortsleeve MJ, Goldenson RS, Perez-Rossello JM, Perlmutter RA, Thorsen A
Y1  - 1998/04/01
N1  - 10.1001/archsurg.133.4.373
JO  - Archives of Surgery
SP  - 373
EP  - 377
VL  - 133
IS  - 4
N2  - Objective 
    To better define the effectiveness of abdominal computed tomographic scanning (ACTS) in adult patients with suspected appendicitis.Design 
    Retrospective analysis.Setting 
    A community teaching hospital.Patients 
    Ninety-seven patients with appendicitis in the differential diagnosis, whose clinical findings were insufficient to perform surgery or to discharge from the hospital, during a 14-month period.Interventions 
    None.Main Outcome Measures 
    Accuracy of ACTS, rate of appendectomies that show no appendicitis (negative appendectomy rate), and frequency of ACTS as a definitive diagnostic test.Results 
    Forty-nine of the 50 patients with appendicitis were correctly diagnosed by ACTS. Forty-three of the 47 patients without appendicitis were correctly diagnosed by ACTS. Positive predictive value was 92%, negative predictive value was 98%, and accuracy was 96%. The ACTS group had a negative appendectomy rate of 5.8% (3/52), lower than the hospital rate of 14% for the preceding 3 years. The ACTS established an alternative diagnosis in 16 patients, allowed 10 other patients to be discharged early or not admitted, and was the critical diagnostic test in 30 of the patients with appendicitis. Therefore, the ACTS played a definitive role in the treatment of 56 (57.7%) of the 97 patients.Conclusions 
    The ACTS was an accurate test in the diagnosis of appendicitis and was of significant benefit in 57.7% of the patients studied. However, it was difficult to predict which patients were most likely to benefit. Expanded selective use of ACTS for patients with clinically indeterminate appendicitis may result in a lower negative appendectomy rate and fewer patient admissions for observation.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.133.4.373
UR  - http://dx.doi.org/10.1001/archsurg.133.4.373
ER  -