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Imaging for suspected appendicitis: negative appendectomy and perforation rates.

Sandra E Bendeck1, Matilde Nino-Murcia, Gerald J Berry

  • 1Department of Radiology, Stanford University Medical Center, 300 Pasteur Dr, Rm H1307, Stanford, CA 94305, USA.

Radiology
|October 2, 2002
PubMed
Summary

Preoperative imaging like CT or US significantly lowers negative appendectomy rates in women with suspected appendicitis. This imaging is not as beneficial for girls, men, or boys.

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Area of Science:

  • Medical Imaging
  • Surgical Outcomes
  • Diagnostic Accuracy

Background:

  • Acute appendicitis is a common surgical emergency.
  • Preoperative imaging aims to improve diagnostic accuracy and reduce negative appendectomy rates.
  • The utility of preoperative imaging varies across patient demographics.

Purpose of the Study:

  • To identify patient groups who benefit from preoperative imaging for suspected acute appendicitis.
  • To compare negative appendectomy and perforation rates with and without preoperative computed tomography (CT) or ultrasonography (US).

Main Methods:

  • Retrospective review of 462 patients undergoing appendectomy for suspected appendicitis.
  • Patients categorized into four groups: women, girls, men, and boys.
  • Analysis of negative appendectomy rates based on preoperative CT, US, or no imaging.

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Main Results:

  • Women undergoing preoperative CT or US had significantly lower negative appendectomy rates (7-8%) compared to those without imaging (28%).
  • Preoperative imaging did not significantly impact negative appendectomy rates in girls, men, or boys.
  • CT and US demonstrated high sensitivity (>93% and >77%) and positive predictive values (>92%) for diagnosing appendicitis across all groups.

Conclusions:

  • Preoperative CT or US is most beneficial for women suspected of acute appendicitis, reducing unnecessary surgeries.
  • Routine preoperative imaging is recommended for women with suspected appendicitis.
  • Further evaluation may be needed to determine optimal imaging strategies for other demographic groups.