| An International Evaluation of Ultrasound vs Computed Tomography in the Diagnosis of Appendicitis. | |
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MedLine Citation:
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PMID: 22035447 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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ABSTRACT: BACKGROUND: Abdominal computed tomography scan (CT) is the preferred radiographic study for the diagnosis of appendicitis in the United States, while radiologist-operated ultrasound (US) is often used in Israel. This comparative international study evaluates the performance of CT vs US in the evaluation of acute appendicitis. METHODS: A retrospective chart analysis was conducted at two tertiary care teaching hospitals, one in each country. Adult patients (age 18-99) with an Emergency Department (ED) working diagnosis of appendicitis between January 1, 2005 and December 31, 2006 were reviewed. Included patients had at least one imaging study, went to the OR, and had documented surgical pathology results. RESULTS: Of 136 patients in the United States with the ED diagnosis of appendicitis, 79 met inclusion criteria for the CT cohort. Based on pathology, CT had a sensitivity of 100% (95% CI 95.4-100%). The negative appendectomy rate in patients with positive CT was 0%. Total median ED length of stay was 533 minutes (IQR<450-632>) and median time from CT order to completion was 184 minutes (IQR<147-228>). Of 520 patients in Israel, 197 were included in the US cohort. Based on final pathology, US had a sensitivity of 68.4% (95% CI 61.2-74.8%). The negative appendectomy rate in patients with positive US was 5.5%. The median ED length of stay for these patients was 387 minutes (IQR<259-571.5>). 23.4% of patients had subsequent CT scans. Median time from US order to completion was 20 minutes (IQR<7-49>). Both time values were p<0.001 when compared with CT. We furthermore calculate that a "first pass" approach of using US first, and then performing a confirmatory CT scan in patients with negative US, would have saved an average of 88.0 minutes per patient in the United States, and avoided CT in 65% of patients. CONCLUSIONS: Radiologist-operated US had inferior sensitivity and positive predictive value when compared with CT, though was significantly faster to perform, and avoided radiation and contrast in a majority of patients. A "first-pass" approach using US first and then CT if US is not diagnostic may be desirable in some institutions. |
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Authors:
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Betzalel Reich; Todd Zalut; Scott G Weiner |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-10-29 |
Journal Detail:
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Title: International journal of emergency medicine Volume: 4 ISSN: 1865-1380 ISO Abbreviation: - Publication Date: 2011 Oct |
Date Detail:
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Created Date: 2011-10-31 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101469435 Medline TA: Int J Emerg Med Country: - |
Other Details:
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Languages: ENG Pagination: 68 Citation Subset: - |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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