The American Journal of Roentgenology advises that a CT of the appendix has a significant impact on the management of emergency department patients who are suspected of having appendicitis.

Dr. Robert Nathan of the University of Washington, Seattle, and colleagues note that despite the apparent value of CT under these circumstances, it has not been determined whether the approach should be used in all such patients.

"The data suggest that CT can be withheld in patients in whom emergency clinicians rate the likelihood of appendicitis as unlikely but that CT findings are often of benefit even when appendicitis is judged to be very likely," Dr. Nathan and colleagues wrote.
The researchers conducted a prospective study of consecutive adult cases at the 300-bed hospital over a four-month period in 2006.

Emergency physicians in this hospital routinely ordered CT scans for all patients with suspected appendicitis. No surgery was performed without CT results.

In addition to performing their standard patient evaluations, physicians also rated the likelihood of appendicitis in each case in five categories, from "unlikely" to "possible" to "equivocal" to "probable" to "very likely."

In three of the five patients in whom appendicitis was considered very likely, CT determined that this was not the case. This was also true of nine of 18 in whom appendicitis was considered to be likely.

However, in all 20 patients considered unlikely to have appendicitis, CT results were in accordance.

Overall, CT scans led to a change in the treatment plans of 29% of the patients. The approach had a sensitivity of 94%, a specificity and positive predictive value of 100%, and a negative predictive value and accuracy of 99%.

"CT of the appendix has an important therapeutic impact in the evaluation of suspected appendicitis in a community hospital emergency department," Dr. Nathan and colleagues concluded.

[Source: AJR October 2008]

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