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Open Access 01-10-2010

Routine Ultrasound and Limited Computed Tomography for the Diagnosis of Acute Appendicitis

Authors: Boudewijn R. Toorenvliet, Fraukje Wiersma, Rutger F. R. Bakker, Jos W. S. Merkus, Paul J. Breslau, Jaap F. Hamming

Published in: World Journal of Surgery | Issue 10/2010

Abstract

Background

Acute appendicitis continues to be a challenging diagnosis. Preoperative radiological imaging using ultrasound (US) or computed tomography (CT) has gained popularity as it may offer a more accurate diagnosis than classic clinical evaluation. The optimal implementation of these diagnostic modalities has yet to be established. The aim of the present study was to investigate a diagnostic pathway that uses routine US, limited CT, and clinical re-evaluation for patients with acute appendicitis.

Methods

A prospective analysis was performed of all patients presenting with acute abdominal pain at the emergency department from June 2005 until July 2006 using a structured diagnosis and management flowchart. Daily practice was mimicked, while ensuring a valid assessment of clinical and radiological diagnostic accuracies and the effect they had on patient management.

Results

A total of 802 patients were included in this analysis. Additional radiological imaging was performed in 96.3% of patients with suspected appendicitis (n = 164). Use of CT was kept to a minimum (17.9%), with a US:CT ratio of approximately 6:1. Positive and negative predictive values for the clinical diagnosis of appendicitis were 63 and 98%, respectively; for US 94 and 97%, respectively; and for CT 100 and 100%, respectively. The negative appendicitis rate was 3.3%, the perforation rate was 23.5%, and the missed perforated appendicitis rate was 3.4%. No (diagnostic) laparoscopies were performed.

Conclusions

A diagnostic pathway using routine US, limited CT, and clinical re-evaluation for patients with acute abdominal pain can provide excellent results for the diagnosis and treatment of appendicitis.

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Title: Routine Ultrasound and Limited Computed Tomography for the Diagnosis of Acute Appendicitis
Authors: Boudewijn R. Toorenvliet
Fraukje Wiersma
Rutger F. R. Bakker
Jos W. S. Merkus
Paul J. Breslau
Jaap F. Hamming
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 10/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0694-y

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Routine Ultrasound and Limited Computed Tomography for the Diagnosis of Acute Appendicitis

Abstract

Background

Methods

Results

Conclusions

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Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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