Appendicitis: Selective Use of Abdominal CT Reduces Negative Appendectomy Rate

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Abstract
Background: Recent literature supports the use of CT for all patients with right lower quadrant pain to improve diagnostic accuracy and reduce hospital cost. Our current practice at a large teaching hospital is to use CT only for patients whose diagnosis remains in question after a thorough history, physical examination, and focused laboratory assessment. In consideration of a more liberal use of CT for right lower quadrant pain, we reviewed our experience with selective CT and the effect this has had on our practice, paying particular attention to perforation rate and negative appendectomy rate. Materials and Methods: A retrospective chart review was performed for all patients who underwent appendectomy in 1995 and 1998. These two patient populations were evaluated for patient demographics, use of CT scan, perforation rate, and incidence of negative appendectomy. Results: Three hundred ninety-four patients underwent appendectomy in 1995 versus 372 in 1998. Gender (64% male in 1995 vs. 60% in 1998), age (mean 24.9 vs. 25.5) and perforation rate (31% in 1995 vs. 29% in 1998) did not change. The use of CT increased in 1998 (12% vs. 34%, p < 0.001) and overall nontherapeutic appendectomy decreased (14% vs. 7%, p < 0.005). This decrease was seen in patients who were operated without CT (13% vs. 7%, p < 0.03) and after CT (19% vs. 6%, p < 0.02). Conclusion: Selective use of CT scan in patients presenting with right lower quadrant pain is helpful in reducing the incidence of nontherapeutic appendectomy.