Approximately 290000 patients in th...

Approximately 290000 patients in the United States underwent pressing appendectomy in 1999. A normal appendix is remov in up to 40 percent of patients who experience surgery because of a preoperative diagnosis of appendicitis. Several studies have reported improved diagnostic accuracy with the incorporation of comput tomography (CT) into clinical decision-making, however other studies have failed to replicate these terminates Perez and colleagues studied the contribution of CT scanning to the accuracy of preoperative diagnosis of appendicitis at a community hospital.

The application of mind included all 118 patients who underwent nonincidental appendectomy between April 1999 and June 2000 at a 300-bed community hospital. The impact of increasing the use of CT scanning in the diagnosis of appendicitis was studied by means of comparing data from these patients with data from 100 patients who underwent nonincidental appendectomy at the same hospital during 1994 Data included patient demographics, diagnostic proofs pathologic diagnoses, antibiotic usage, complications, duration of necessity department treatment, and length of hospital stay.

The pair groups of patients were comparable in all important esteems Preoperative CT scanning was performed in 11 percent of patients in the 1994 cohort and 483 percent of those in the 1999-2000 cohort. In spite of the more than fourfold increase in preoperative CT scans, the percentage of normal appendixes remov increased (nonsignificantly) from 12 percent to 178 percent Furthermore, the diagnostic accuracy of the CT scans did not improve significantly between the pair study periods. In the 1994 application of mind CT accuracy was 81.8 percent compared with 807 percent in the 1999-2000 meditation The authors calculate that CT scanning did not add to the post-test probability of correctly diagnosing appendicitis or accurately ruling revealed appendicitis. The patients who underwent CT scanning wearied a significantly longer time in the pass department and had a longer hospital stay than the patients who did not suffer CT scanning. The authors end that widespread use of CT scanning has not improved the accuracy of diagnosing appendicitis and has contributed to longer push department and hospital stays. These comes confirm the findings of several previous studies on the other hand contradict the findings of other studies in which CT scanning reduc the number of normal appendixes that were remov The authors of the current study speculate that the differences may be explained by means of the technique of CT used. Investigations using oral, rectal, or intravenous contrast media may have greater accuracy however may be more difficult to escort successfully in an emergency situation.

Perez J et al. Liberal use of comput tomography scanning does not improve diagnostic accuracy in appendicitis. Am J Surg March 2003;185:194-7

COPYRIGHT 2003 American Academy of Family Physicians

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