Preoperative CT Scans for Presumed Appendicitis Should Be Used More Selectively: Presented at DDW

Preoperative computed tomography (CT) scanning of patients with presumed appendicitis should be used very selectively, since they can delay surgical intervention and lead to an increased risk of perforation, researchers reported here at Digestive Diseases Week (DDW).

"Our findings suggest that CT scanning is used too often and contributes to delays that, in turn, cause a higher perforation rate," said presenter and investigator Herbert Chen, MD, assistant professor, division of general surgery, and chief, endocrine surgery, University of Wisconsin School of Medicine, Madison, Wisconsin, United States.

Dr. Chen discussed the findings of his study in a press briefing on May 22nd.

"This situation seems to be driven largely by medical-legal concerns," added briefing moderator Gregory Ginsberg, MD, director, endoscopic services, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States.

Dr. Chen and colleagues analysed retrospectively CT scan records of adult patients with appendicitis at the University of Wisconsin Hospital in Madison to determine the sensitivity, specificity, and effect on clinical outcome. They correlated surgical findings, including incidence of perforation, to imaging results.

During a 3-year period, 410 subjects underwent appendectomy for presumed acute appendicitis, and 255 (62%) underwent preoperative CT scanning. The other 155 subjects (38%) did not undergo CT imaging before surgery.

Mean white blood cell counts at presentation in the emergency room were similar between the 2 groups.

The researchers reported that CT had a 93% overall sensitivity but only a 59% specificity for acute appendicitis.

Patients who were given CT scanning were older and were more likely to be female. They also waited longer between admission and surgery than those who were not scanned (8.2 vs 5.1 hours).

Notably, perforation appeared in 17% of those who were scanned compared with 8% of those who were not scanned.

"The potential delay that associated with higher perforation leads us to believe that CT should be used more selectively," Dr. Chen said.
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