Original Paper

CT Scan in Patients with Suspected Appendicitis: Clinical Implications for the Acute Care Surgeon
M. Petrosyan, J. Estrada, S. Chan, S. Somers, W.N. Yacoub, R.L. Kelso, R.J. Mason

Division of Emergency Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California and Los Angeles County + USC Medical Center, Los Angeles, Calif., USA

Address of Corresponding Author

Eur Surg Res 2008;40:211-219 (DOI: 10.1159/000110863)

  Key Words

• Alvarado score, acute appendicitis
• Appendicitis
• CT scan, appendicitis diagnosis

  Abstract

Objective: To determine the influence of computed tomography (CT) scans on diagnosis and management of patients with suspected appendicitis. Methods: Retrospective 2-year review of 1,630 patients with suspected appendicitis, categorized into three groups based on the likelihood (Alvarado scores) of having appendicitis. Group 1: low likelihood (Alvarado score 4); group 2: intermediate likelihood (Alvarado scores 5-7), and group 3: high likelihood (Alvarado score 8). CT scan utilization, hospital course, and final pathology were retrospectively reviewed. Results: More patients received a CT scan in 2006 as compared with 2005 (60 vs. 52%; p = 0.001). The overall appendectomy rate was similar between the 2 years (57% in 2005 vs. 57% in 2006; p = 0.995). The overall appendectomy rate in patients with a CT was significantly higher as compared with those without (60 vs. 53%; p = 0.002). The appendectomy rate in patients with Alvarado scores 4 and no CT scan was significantly lower than in those with a CT scan (12 vs. 48%; p < 0.0001). The overall negative appendectomy rate in patients with a CT scan was similar to that in those without: 31/546 (6%) vs. 23/383 (6%). Conclusions: CT scan utilization increased the appendectomy rate only in patients with a low clinical suspicion for appendicitis. Preoperative CT scans did not decrease the negative appendectomy rate.

Copyright © 2008 S. Karger AG, Basel

  Author Contacts

Rodney J. Mason, MD, PhD
1200 North State Street, No. 10850
Los Angeles, CA 90033 (USA)
Tel. +1 323 226 7720, Fax +1 323 226 5996
E-Mail rmason@surgery.usc.edu

  Article Information

Presented in part at the 42nd Congress of the European Society for Surgical Research (ESSR), Rotterdam, The Netherlands, May 2007.

Received: May 25, 2007
Accepted after revision: August 22, 2007
Published online: November 12, 2007
Number of Print Pages : 9
Number of Figures : 3, Number of Tables : 3, Number of References : 44