High-Quality Preoperative CT Scans Help Reduce Unnecessary Appendix Surgery
Drs. Steven Raman and colleagues Ferdnand Osuagwu, Barbara Kadell and David Lu of the UCLA Radiology Abdominal Imaging Division reported in the February 28th issue of the New England Journal of Medicine, the results of a study suggesting that the increased use of high-quality preoperative CT has led to significantly improved clinical outcomes in adults, with a dramatic and sustained decrease in the rate of false positive diagnosis of appendicitis and also a decrease in rates of appendiceal perforation.
The retrospective review of data from 1081 adults, from 1996 to 2006, revealed that the annual rate of use of pre-operative CT among patients who underwent surgery for suspected acute appendicitis increased from 20% in 1996 to 85% in 2006.
EFFECT OF CT SCANS on False Positive Diagnosis of Appendicitis & Perforation "The increased use of high-quality preoperative CT has led to improved clinical outcomes with a dramatic and sustained decrease in the rate of false positive diagnosis of appendicitis and also a decrease in rates of appendiceal perforation."
Steven Raman, MD
Ferdnand Osuagwu, MD
Barbara Kadell, MD
David Lu, MD
Although acute appendicitis is the most common reason for patients to present to the Emergency Department with abdominal pain, the diagnosis is difficult in up to 20% of men and 40% of women, leading to unnecessary surgery.
During this 10-year period, the overall rate of false positive diagnosis of appendicitis among adults decreased nearly 90%, from 24% in 1996 to 3% in 2006. Thus the rate of unnecessary appendectomies had been decreased substantially over this time. Further, the rate of serious and potentially dangerous perforated appendicitis also decreased over this period.
The study has built upon prior work by Dr. Raman that demonstrated that a high quality CT has over 95% accuracy in diagnosing appendicitis or an alternative diagnosis such as diverticulitis or cholecystitis.
Reuters also reported this result on February 27th. "CT Scans Lower Risk of Unnecessary Appendix Surgery."