Original scientific articleComputed Tomography-Based Clinical Diagnostic Pathway for Acute Appendicitis: Prospective Validation
Section snippets
Retrospective analysis (PRE group)
Data from the most recent year of our previous retrospective review7 were analyzed, consisting of all nonpregnant patients older than 14 years of age who underwent appendectomy or CT for suspected appendicitis at our institution between August 2001 and August 2002. Patients undergoing incidental appendectomy were excluded. Variables collected included age, gender, WBC, CT scan results, and pathologic findings. All pathology reports were reviewed to confirm diagnoses and perforation, with review
Retrospective analysis (PRE group)
Between August 2001 and August 2002, data were compiled on 383 patients presenting to our facility with possible appendicitis. Eighty percent (305 of 383) of patients underwent CT, which was interpreted as positive for appendicitis in 33% (102 of 305). CT during this time period had a 97% (196 of 203) negative predictive value (NPV), which increased to 99% (201 of 203) when accompanied by a normal serum WBC (< 10.5 103/mm3).
Fifty-one percent (196 of 383) of these patients underwent operation
Discussion
Acute appendicitis is the most common cause of an acute abdomen and the need for acute surgical intervention in the Western Hemisphere. The estimated lifetime risk of undergoing appendectomy for suspected acute appendicitis is between 7% and 12%, and approximately 250,000 appendectomies for suspected appendicitis are performed in the US each year.1 Despite advances in surgical diagnosis, the accuracy of clinical diagnosis in acute appendicitis is not > 85% in most series with NA rates of up to
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Competing Interests Declared: None.
The Chief, Bureau of Medicine and Surgery, Navy Department, Washington, DC, Clinical Investigation Program sponsored this report no. S-04-035 as required by NSHSBETHINST 6000.41A. The article represents the personal viewpoint of the authors and cannot be construed as a statement of official Department of the Navy, Department of Defense, or the United States Government policy.