Document Detail

Low-dose abdominal CT for evaluating suspected appendicitis.
MedLine Citation:
PMID:  22533576     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Computed tomography (CT) has become the predominant test for diagnosing acute appendicitis in adults. In children and young adults, exposure to CT radiation is of particular concern. We evaluated the rate of negative (unnecessary) appendectomy after low-dose versus standard-dose abdominal CT in young adults with suspected appendicitis.
METHODS: In this single-institution, single-blind, noninferiority trial, we randomly assigned 891 patients with suspected appendicitis to either low-dose CT (444 patients) or standard-dose CT (447 patients). The median radiation dose in terms of dose-length product was 116 mGy·cm in the low-dose group and 521 mGy·cm in the standard-dose group. The primary end point was the percentage of negative appendectomies among all nonincidental appendectomies, with a noninferiority margin of 5.5 percentage points. Secondary end points included the appendiceal perforation rate and the proportion of patients with suspected appendicitis who required additional imaging.
RESULTS: The negative appendectomy rate was 3.5% (6 of 172 patients) in the low-dose CT group and 3.2% (6 of 186 patients) in the standard-dose CT group (difference, 0.3 percentage points; 95% confidence interval, -3.8 to 4.6). The two groups did not differ significantly in terms of the appendiceal perforation rate (26.5% with low-dose CT and 23.3% with standard-dose CT, P=0.46) or the proportion of patients who needed additional imaging tests (3.2% and 1.6%, respectively; P=0.09).
CONCLUSIONS: Low-dose CT was noninferior to standard-dose CT with respect to negative appendectomy rates in young adults with suspected appendicitis. (Funded by GE Healthcare Medical Diagnostics and others; number, NCT00913380.).
Kyuseok Kim; Young Hoon Kim; So Yeon Kim; Suyoung Kim; Yoon Jin Lee; Kwang Pyo Kim; Hye Seung Lee; Soyeon Ahn; Taeyun Kim; Seung-sik Hwang; Ki Jun Song; Sung-Bum Kang; Duck-Woo Kim; Seong Ho Park; Kyoung Ho Lee
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  366     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-26     Completed Date:  2012-04-27     Revised Date:  2013-01-25    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1596-605     Citation Subset:  AIM; IM    
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
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MeSH Terms
Appendicitis / radiography*,  surgery
False Positive Reactions
Radiation Dosage
Single-Blind Method
Tomography, X-Ray Computed / methods*
Young Adult
Comment In:
N Engl J Med. 2012 Aug 2;367(5):477; author reply 478-9   [PMID:  22853026 ]
Radiologe. 2012 Dec;52(12):1089-90   [PMID:  23114710 ]
N Engl J Med. 2012 Aug 2;367(5):478; author reply 478-9   [PMID:  22853027 ]

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