Scientific paperThe use of abdominal computed tomography scan decreases the frequency of misdiagnosis in cases of suspected appendicitis
Section snippets
Patients and methods
We performed a retrospective chart review of 114 consecutive adult patients who had nonincidental appendectomy between July 1998 and June 2000. There were 36 women and 78 men with an age range of 17 to 67 years and an average age of 35 years. In July 2000 we introduced a clinical guideline that encourages the use of abdominal CT scan for all nonpregnant adults in whom the diagnosis of appendicitis was suspected unless either the diagnosis of appendicitis could be excluded based on history,
Results
There were 194 appendectomies performed, 114 were done prior to the guideline encouraging use of abdominal CT and 80 after the development of the clinical guideline (Table 1). In the preguideline period 36 (32%) patients had a preoperative CT scan of the abdomen. Twenty-eight (25%) patients in the preguideline period were found to have a normal appendix. The rate of misdiagnosis in women was 47%. In the postguideline period 67 (84%) of 80 patients had a preoperative CT scan. Only 5 patients
Comments
The study demonstrates that abdominal CT can be used to increase diagnostic accuracy in patients with suspected appendicitis in whom the diagnosis could not be ruled out based on history, physical examination, and laboratory data or in whom the diagnosis of appendicitis with evidence of peritonitis was not obvious. The utilization of abdominal CT in patients undergoing appendectomy increased from 32% to 84% (P <0.05). The frequency of misdiagnosis of appendicitis was reduced from 25% to 6% (P
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