Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis

S. L. Lee, A. J. Walsh, H. S. Ho, Wayne H Schwesinger, J. L. Grosfeld, J. Kuhn, K. W. Millikan, E. T. Peter

Research output: Contribution to journalArticle

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Abstract

Hypothesis: Computed tomography (CT) and ultrasonography (US) do not improve the overall diagnostic accuracy for acute appendicitis. Design: Retrospective review. Setting: University tertiary care center. Patients: Seven hundred sixty-six consecutive patients undergoing appendectomy for suspected appendicitis from January 1, 1995, to December 31, 1999. Main Outcome Measures: Epidemiology of acute appendicitis and the roles of clinical assessment, CT, US, and laparoscopy. Results: The negative appendectomy rate was 15.7%, and the incidence of perforated appendicitis was 14.6%. A history of migratory pain had the highest positive predictive value (91%), followed by leukocytosis greater than 12 × 109/L (90.1%), CT (83.8%), and US (81.3%). The false-negative rates were 60% for CT and 76.1% for US. Emergency department evaluation took a mean±SD of 5.2±5.4 hours and was prolonged by US or CT (6.4±7.4 h and 7.8±10.8 h, respectively). The duration of emergency department evaluation did not affect the perforation rate, but patients with postoperative complications had longer evaluations (mean±SD, 8.0±12.7 h) than did those without (4.8±3.3 h) (P=.04). Morbidity was 9.1%, 6.4% for nonperforated cases and 19.8% for perforated cases. Seventy-six patients had laparoscopic appendectomy, with a negative appendectomy rate of 42.1%, compared with 15.4% for open appendectomy (P<.001). Laparoscopy, however, had minimal morbidity (1.3%) and correctly identified the abnormality in 91.6% of patients who had a normal-appearing appendix. Conclusions: Migratory pain, physical examination, and initial leukocytosis remain reliable and accurate in diagnosing acute appendicitis. Neither CT nor US improves the diagnostic accuracy or the negative appendectomy rate; in fact, they may delay surgical consultation and appendectomy. In atypical cases, one should consider the selective use of diagnostic laparoscopy instead.

Original languageEnglish (US)
Pages (from-to)556-562
Number of pages7
JournalArchives of Surgery
Volume136
Issue number5
StatePublished - 2001
Externally publishedYes

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Appendectomy
Appendicitis
Ultrasonography
Tomography
Laparoscopy
Leukocytosis
Therapeutics
Hospital Emergency Service
Morbidity
Pain
Tertiary Care Centers
Physical Examination
Epidemiology
Referral and Consultation
Outcome Assessment (Health Care)
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Lee, S. L., Walsh, A. J., Ho, H. S., Schwesinger, W. H., Grosfeld, J. L., Kuhn, J., ... Peter, E. T. (2001). Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Archives of Surgery, 136(5), 556-562.

Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. / Lee, S. L.; Walsh, A. J.; Ho, H. S.; Schwesinger, Wayne H; Grosfeld, J. L.; Kuhn, J.; Millikan, K. W.; Peter, E. T.

In: Archives of Surgery, Vol. 136, No. 5, 2001, p. 556-562.

Research output: Contribution to journalArticle

Lee, SL, Walsh, AJ, Ho, HS, Schwesinger, WH, Grosfeld, JL, Kuhn, J, Millikan, KW & Peter, ET 2001, 'Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis', Archives of Surgery, vol. 136, no. 5, pp. 556-562.
Lee SL, Walsh AJ, Ho HS, Schwesinger WH, Grosfeld JL, Kuhn J et al. Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. Archives of Surgery. 2001;136(5):556-562.
Lee, S. L. ; Walsh, A. J. ; Ho, H. S. ; Schwesinger, Wayne H ; Grosfeld, J. L. ; Kuhn, J. ; Millikan, K. W. ; Peter, E. T. / Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis. In: Archives of Surgery. 2001 ; Vol. 136, No. 5. pp. 556-562.
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abstract = "Hypothesis: Computed tomography (CT) and ultrasonography (US) do not improve the overall diagnostic accuracy for acute appendicitis. Design: Retrospective review. Setting: University tertiary care center. Patients: Seven hundred sixty-six consecutive patients undergoing appendectomy for suspected appendicitis from January 1, 1995, to December 31, 1999. Main Outcome Measures: Epidemiology of acute appendicitis and the roles of clinical assessment, CT, US, and laparoscopy. Results: The negative appendectomy rate was 15.7{\%}, and the incidence of perforated appendicitis was 14.6{\%}. A history of migratory pain had the highest positive predictive value (91{\%}), followed by leukocytosis greater than 12 × 109/L (90.1{\%}), CT (83.8{\%}), and US (81.3{\%}). The false-negative rates were 60{\%} for CT and 76.1{\%} for US. Emergency department evaluation took a mean±SD of 5.2±5.4 hours and was prolonged by US or CT (6.4±7.4 h and 7.8±10.8 h, respectively). The duration of emergency department evaluation did not affect the perforation rate, but patients with postoperative complications had longer evaluations (mean±SD, 8.0±12.7 h) than did those without (4.8±3.3 h) (P=.04). Morbidity was 9.1{\%}, 6.4{\%} for nonperforated cases and 19.8{\%} for perforated cases. Seventy-six patients had laparoscopic appendectomy, with a negative appendectomy rate of 42.1{\%}, compared with 15.4{\%} for open appendectomy (P<.001). Laparoscopy, however, had minimal morbidity (1.3{\%}) and correctly identified the abnormality in 91.6{\%} of patients who had a normal-appearing appendix. Conclusions: Migratory pain, physical examination, and initial leukocytosis remain reliable and accurate in diagnosing acute appendicitis. Neither CT nor US improves the diagnostic accuracy or the negative appendectomy rate; in fact, they may delay surgical consultation and appendectomy. In atypical cases, one should consider the selective use of diagnostic laparoscopy instead.",
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T1 - Computed tomography and ultrasonography do not improve and may delay the diagnosis and treatment of acute appendicitis

AU - Lee, S. L.

AU - Walsh, A. J.

AU - Ho, H. S.

AU - Schwesinger, Wayne H

AU - Grosfeld, J. L.

AU - Kuhn, J.

AU - Millikan, K. W.

AU - Peter, E. T.

PY - 2001

Y1 - 2001

N2 - Hypothesis: Computed tomography (CT) and ultrasonography (US) do not improve the overall diagnostic accuracy for acute appendicitis. Design: Retrospective review. Setting: University tertiary care center. Patients: Seven hundred sixty-six consecutive patients undergoing appendectomy for suspected appendicitis from January 1, 1995, to December 31, 1999. Main Outcome Measures: Epidemiology of acute appendicitis and the roles of clinical assessment, CT, US, and laparoscopy. Results: The negative appendectomy rate was 15.7%, and the incidence of perforated appendicitis was 14.6%. A history of migratory pain had the highest positive predictive value (91%), followed by leukocytosis greater than 12 × 109/L (90.1%), CT (83.8%), and US (81.3%). The false-negative rates were 60% for CT and 76.1% for US. Emergency department evaluation took a mean±SD of 5.2±5.4 hours and was prolonged by US or CT (6.4±7.4 h and 7.8±10.8 h, respectively). The duration of emergency department evaluation did not affect the perforation rate, but patients with postoperative complications had longer evaluations (mean±SD, 8.0±12.7 h) than did those without (4.8±3.3 h) (P=.04). Morbidity was 9.1%, 6.4% for nonperforated cases and 19.8% for perforated cases. Seventy-six patients had laparoscopic appendectomy, with a negative appendectomy rate of 42.1%, compared with 15.4% for open appendectomy (P<.001). Laparoscopy, however, had minimal morbidity (1.3%) and correctly identified the abnormality in 91.6% of patients who had a normal-appearing appendix. Conclusions: Migratory pain, physical examination, and initial leukocytosis remain reliable and accurate in diagnosing acute appendicitis. Neither CT nor US improves the diagnostic accuracy or the negative appendectomy rate; in fact, they may delay surgical consultation and appendectomy. In atypical cases, one should consider the selective use of diagnostic laparoscopy instead.

AB - Hypothesis: Computed tomography (CT) and ultrasonography (US) do not improve the overall diagnostic accuracy for acute appendicitis. Design: Retrospective review. Setting: University tertiary care center. Patients: Seven hundred sixty-six consecutive patients undergoing appendectomy for suspected appendicitis from January 1, 1995, to December 31, 1999. Main Outcome Measures: Epidemiology of acute appendicitis and the roles of clinical assessment, CT, US, and laparoscopy. Results: The negative appendectomy rate was 15.7%, and the incidence of perforated appendicitis was 14.6%. A history of migratory pain had the highest positive predictive value (91%), followed by leukocytosis greater than 12 × 109/L (90.1%), CT (83.8%), and US (81.3%). The false-negative rates were 60% for CT and 76.1% for US. Emergency department evaluation took a mean±SD of 5.2±5.4 hours and was prolonged by US or CT (6.4±7.4 h and 7.8±10.8 h, respectively). The duration of emergency department evaluation did not affect the perforation rate, but patients with postoperative complications had longer evaluations (mean±SD, 8.0±12.7 h) than did those without (4.8±3.3 h) (P=.04). Morbidity was 9.1%, 6.4% for nonperforated cases and 19.8% for perforated cases. Seventy-six patients had laparoscopic appendectomy, with a negative appendectomy rate of 42.1%, compared with 15.4% for open appendectomy (P<.001). Laparoscopy, however, had minimal morbidity (1.3%) and correctly identified the abnormality in 91.6% of patients who had a normal-appearing appendix. Conclusions: Migratory pain, physical examination, and initial leukocytosis remain reliable and accurate in diagnosing acute appendicitis. Neither CT nor US improves the diagnostic accuracy or the negative appendectomy rate; in fact, they may delay surgical consultation and appendectomy. In atypical cases, one should consider the selective use of diagnostic laparoscopy instead.

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