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Clinical Trial
. 2010 Oct;34(10):2278-85.
doi: 10.1007/s00268-010-0694-y.

Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis

Boudewijn R Toorenvliet  1 , Fraukje Wiersma, Rutger F R Bakker, Jos W S Merkus, Paul J Breslau, Jaap F Hamming
Affiliations
Clinical Trial

Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis

Boudewijn R Toorenvliet et al. World J Surg. 2010 Oct.

Abstract

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.

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Figures

Fig. 1
Fig. 1
Study design for patients presenting with abdominal pain at the emergency department for surgical consultation
Fig. 2
Fig. 2
Diagnostic changes between the clinical diagnosis at initial evaluation (D1) and the final diagnosis (FD)
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