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Helical CT Is More Accurate Than Clinical Judgment for Diagnosing Appendicitis

Even in cases of clinically apparent appendicitis

The role of multidetector computed tomography (MDCT) scanning in the diagnosis of appendicitis is evolving as technology and resolution improve. Researchers in Korea compared the diagnostic accuracy of 16-detector MDCT scanning and clinical impression in 157 consecutive patients who presented to two emergency departments with signs or symptoms that raised concern for possible appendicitis.

All patients were evaluated by emergency physicians and senior residents who determined whether the clinical diagnosis was appendicitis. All patients then underwent MDCT with intravenous contrast only. MDCT scans were read by two radiologists who specialized in CT interpretation. The final diagnosis of appendicitis was based on surgical pathology or clinical follow-up. The positive predictive value of the examining physician’s clinical impression was 73%, and the negative predictive value was 56%. Corresponding values for MDCT were 97% and 97%.

Comment: These findings suggest that MDCT scanning is more accurate than clinical judgment for diagnosing appendicitis, even in cases that are considered to be "clinically apparent." However, not all radiologists who interpret CT scans are CT specialists, and CT scans are not read by two radiologists in most EDs. Patients with suspected appendicitis, especially women, should undergo abdominal CT scanning to confirm or exclude the diagnosis, with the exception of patients whose diagnosis is considered "certain" by the attending surgeon and who are taken directly to the operating room without imaging.

— Diane M. Birnbaumer, MD, FACEP

Published in Journal Watch Emergency Medicine September 5, 2008

Citation(s):

Kim K et al. Impact of helical computed tomography in clinically evident appendicitis. Emerg Med J 2008 Aug; 25:477.

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