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The Role of Multidetector Computed Tomography for Diagnosing Acute Appendicitis FREE

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The full report is titled “Diagnostic Performance of Multidetector Computed Tomography for Suspected Acute Appendicitis.” It is in the 21 June 2011 issue of Annals of Internal Medicine (volume 154, pages 789-796). The authors are P.J. Pickhardt, E.M. Lawrence, B.D. Pooler, and R.J. Bruce.

Ann Intern Med. 2011;154(12):I-36. doi:10.7326/0003-4819-154-12-201106210-00002
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What is the problem and what is known about it so far?

Acute appendicitis is one of the most common causes of sudden, severe abdominal pain. It usually requires emergency removal of the appendix, a surgical procedure called an appendectomy. Diagnosis can be difficult because no single sign, symptom, or test can accurately confirm the diagnosis in all cases before surgery. Doctors often use computed tomography (CT or “CAT”) scans, which allow them to view the inside of the abdomen and pelvis in a quick, noninvasive manner. Newer, multidetector CT provides clearer images than older CT technology.

Why did the researchers do this particular study?

To learn the accuracy of multidetector CT for diagnosing acute appendicitis.

Who was studied?

2871 adults with suspected appendicitis.

How was the study done?

Patients were referred to an academic medical center to receive nonfocused multidetector CT imaging of the abdomen and pelvis within 24 to 48 hours. Radiologists viewed the images and determined which patients seemed to have acute appendicitis and which did not. When no signs of acute appendicitis were found, the radiologists provided an alternative diagnosis. Patients in whom the radiologists diagnosed acute appendicitis underwent appendectomy, and the surgeons documented whether acute appendicitis was actually present. Doctors followed patients who did not need surgery for at least 12 months to exclude a delayed diagnosis.

What did the researchers find?

The radiologists identified 708 patients as having acute appendicitis. Surgeons confirmed this diagnosis in 665 patients. The radiologists ruled out the diagnosis of acute appendicitis in 2163 patients; of these, acute appendicitis was later diagnosed in 10. Increased use of multidetector CT over time coincided with fewer perforations (28.9% in 2000 vs. 11.6% in 2009). Because perforations are more likely to occur when treatment is delayed, this suggests that the scans aided earlier diagnosis and treatment and may have reduced complications. Patients whose appendix has perforated are sicker and often have a longer hospital stay than patients without perforation. Multidetector CT helped detect an alternative diagnosis in patients with abdominal pain but without appendicitis.

What were the limitations of the study?

Because the use of multidetector CT for suspected appendicitis is common, the results could not be compared with those of patients who did not have the same imaging. Some patients with acute appendicitis who had no signs or symptoms may not have been referred for the scan and thus not included in the study.

What are the implications of the study?

Multidetector CT of the abdomen and pelvis is a useful test for evaluating adults with suspected appendicitis.





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