A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis

John J. Hong, Nicholas Namias, Giovanni Gianotti, J. Martin Perez, Adrian Ong, Jeffrey Augenstein, Patricia Byers, Enrique Ginzburg, David Shatz, Danny Sleeman, Stephen M. Cohn, A. Peter Ekeh, Martin Newman, Moises Salama, Suzanne D. Leblang, Julie Jackowski, Mark G. McKenney, Margaret Brown

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background: The objective of this study was to determine if routine use of computed tomography (CT) for the diagnosis of appendicitis is warranted. Methods: During a one-year study period, all patients who presented to the surgical service with possible appendicitis were studied. One hundred eighty-two patients with possible appendicitis were randomized to clinical assessment (CA) alone, or clinical evaluation and abdominal/pelvic CT. A true-positive case resulted in a laparotomy that revealed a lesion requiring operation. A true-negative case did not require operation at one-week follow-up evaluation. Hospital length of stay, hospital charges, perforation rates, and times to operation were recorded. Results: The age and gender distributions were similar in both groups. Accuracy was 90% in the CA group and 92% for CT. Sensitivity was 100% for the CA group and 91% for the CT group. Specificity was 73% for CA and 93% for CT. There were no statistically significant differences in hospital length of stay (CA = 2.4 ± 3.2 days vs. CT = 2.2 ± 2.2 days, p = 0.55), hospital charges (CA = $10,728 ± 10,608 vs. CT = $10,317 ± 7,173, p = 0.73) or perforation rates (CA = 6% vs. CT = 9%, P = 0.4). Time to the operating room was shorter in the CA group, 10.6 ± 8.4 h vs. CT, 19.0 ± 19.0 h (p < 0.01). Conclusions: Clinical assessment unaided by CT reliably identifies patients who need operation for acute appendicitis, and they undergo surgery sooner. Routine use of abdominal/pelvic CT is not warranted. Further research is needed to identify sub-groups of patients who may benefit from CT. Computed tomography should not be considered the standard of care for the diagnosis of appendicitis.

Original languageEnglish (US)
Pages (from-to)231-239
Number of pages9
JournalSurgical Infections
Volume4
Issue number3
StatePublished - Sep 2003
Externally publishedYes

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Appendicitis
Tomography
Prospective Studies
Length of Stay
Hospital Charges
Age Distribution
Operating Rooms
Standard of Care
Laparotomy

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)

Cite this

Hong, J. J., Namias, N., Gianotti, G., Perez, J. M., Ong, A., Augenstein, J., ... Brown, M. (2003). A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surgical Infections, 4(3), 231-239.

A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. / Hong, John J.; Namias, Nicholas; Gianotti, Giovanni; Perez, J. Martin; Ong, Adrian; Augenstein, Jeffrey; Byers, Patricia; Ginzburg, Enrique; Shatz, David; Sleeman, Danny; Cohn, Stephen M.; Ekeh, A. Peter; Newman, Martin; Salama, Moises; Leblang, Suzanne D.; Jackowski, Julie; McKenney, Mark G.; Brown, Margaret.

In: Surgical Infections, Vol. 4, No. 3, 09.2003, p. 231-239.

Research output: Contribution to journalArticle

Hong, JJ, Namias, N, Gianotti, G, Perez, JM, Ong, A, Augenstein, J, Byers, P, Ginzburg, E, Shatz, D, Sleeman, D, Cohn, SM, Ekeh, AP, Newman, M, Salama, M, Leblang, SD, Jackowski, J, McKenney, MG & Brown, M 2003, 'A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis', Surgical Infections, vol. 4, no. 3, pp. 231-239.
Hong JJ, Namias N, Gianotti G, Perez JM, Ong A, Augenstein J et al. A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. Surgical Infections. 2003 Sep;4(3):231-239.
Hong, John J. ; Namias, Nicholas ; Gianotti, Giovanni ; Perez, J. Martin ; Ong, Adrian ; Augenstein, Jeffrey ; Byers, Patricia ; Ginzburg, Enrique ; Shatz, David ; Sleeman, Danny ; Cohn, Stephen M. ; Ekeh, A. Peter ; Newman, Martin ; Salama, Moises ; Leblang, Suzanne D. ; Jackowski, Julie ; McKenney, Mark G. ; Brown, Margaret. / A prospective randomized study of clinical assessment versus computed tomography for the diagnosis of acute appendicitis. In: Surgical Infections. 2003 ; Vol. 4, No. 3. pp. 231-239.
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abstract = "Background: The objective of this study was to determine if routine use of computed tomography (CT) for the diagnosis of appendicitis is warranted. Methods: During a one-year study period, all patients who presented to the surgical service with possible appendicitis were studied. One hundred eighty-two patients with possible appendicitis were randomized to clinical assessment (CA) alone, or clinical evaluation and abdominal/pelvic CT. A true-positive case resulted in a laparotomy that revealed a lesion requiring operation. A true-negative case did not require operation at one-week follow-up evaluation. Hospital length of stay, hospital charges, perforation rates, and times to operation were recorded. Results: The age and gender distributions were similar in both groups. Accuracy was 90{\%} in the CA group and 92{\%} for CT. Sensitivity was 100{\%} for the CA group and 91{\%} for the CT group. Specificity was 73{\%} for CA and 93{\%} for CT. There were no statistically significant differences in hospital length of stay (CA = 2.4 ± 3.2 days vs. CT = 2.2 ± 2.2 days, p = 0.55), hospital charges (CA = $10,728 ± 10,608 vs. CT = $10,317 ± 7,173, p = 0.73) or perforation rates (CA = 6{\%} vs. CT = 9{\%}, P = 0.4). Time to the operating room was shorter in the CA group, 10.6 ± 8.4 h vs. CT, 19.0 ± 19.0 h (p < 0.01). Conclusions: Clinical assessment unaided by CT reliably identifies patients who need operation for acute appendicitis, and they undergo surgery sooner. Routine use of abdominal/pelvic CT is not warranted. Further research is needed to identify sub-groups of patients who may benefit from CT. Computed tomography should not be considered the standard of care for the diagnosis of appendicitis.",
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AU - Namias, Nicholas

AU - Gianotti, Giovanni

AU - Perez, J. Martin

AU - Ong, Adrian

AU - Augenstein, Jeffrey

AU - Byers, Patricia

AU - Ginzburg, Enrique

AU - Shatz, David

AU - Sleeman, Danny

AU - Cohn, Stephen M.

AU - Ekeh, A. Peter

AU - Newman, Martin

AU - Salama, Moises

AU - Leblang, Suzanne D.

AU - Jackowski, Julie

AU - McKenney, Mark G.

AU - Brown, Margaret

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N2 - Background: The objective of this study was to determine if routine use of computed tomography (CT) for the diagnosis of appendicitis is warranted. Methods: During a one-year study period, all patients who presented to the surgical service with possible appendicitis were studied. One hundred eighty-two patients with possible appendicitis were randomized to clinical assessment (CA) alone, or clinical evaluation and abdominal/pelvic CT. A true-positive case resulted in a laparotomy that revealed a lesion requiring operation. A true-negative case did not require operation at one-week follow-up evaluation. Hospital length of stay, hospital charges, perforation rates, and times to operation were recorded. Results: The age and gender distributions were similar in both groups. Accuracy was 90% in the CA group and 92% for CT. Sensitivity was 100% for the CA group and 91% for the CT group. Specificity was 73% for CA and 93% for CT. There were no statistically significant differences in hospital length of stay (CA = 2.4 ± 3.2 days vs. CT = 2.2 ± 2.2 days, p = 0.55), hospital charges (CA = $10,728 ± 10,608 vs. CT = $10,317 ± 7,173, p = 0.73) or perforation rates (CA = 6% vs. CT = 9%, P = 0.4). Time to the operating room was shorter in the CA group, 10.6 ± 8.4 h vs. CT, 19.0 ± 19.0 h (p < 0.01). Conclusions: Clinical assessment unaided by CT reliably identifies patients who need operation for acute appendicitis, and they undergo surgery sooner. Routine use of abdominal/pelvic CT is not warranted. Further research is needed to identify sub-groups of patients who may benefit from CT. Computed tomography should not be considered the standard of care for the diagnosis of appendicitis.

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