EFFECT OF COMPUTED-TOMOGRAPHY OF THE APPENDIX ON TREATMENT OF PATIENTS AND USE OF HOSPITAL RESOURCES

Background In patients with clinically suspected appendicitis, compute d tomography (CT) is diagnostically accurate. However, the effect of r outine CT of the appendix on the treatment of such patients and the us e of hospital resources is unknown. Method's We performed appendiceal CT on 100 consecutive patients in the emergency department who, on the basis of history, physical examination, and laboratory results, were to be hospitalized for observation for suspected appendicitis or for u rgent appendectomy. Outcomes were determined at surgery and by patholo gical examination in 59 patients, and by clinical follow-up two months later in 41 patients. Treatment plans made before CT were compared wi th the patients' actual treatment, We also determined the costs of sur gery that revealed no appendicitis (from data on 61 patients), one day of observation in the hospital (from data on 350 patient-days in pati ents with suspected appendicitis), and appendiceal CT (from data on al l pelvic CT examinations in 1996). Results Fifty-three patients had ap pendicitis, and 47 did not. The interpretations of the appendiceal CT scans were 98 percent accurate. The results of CT led to changes in th e treatment of 59 patients. These changes resulted in the prevention o f unnecessary appendectomy in 13 patients, admission to the hospital f or observation in 18 patients, admission to the hospital for observati on before necessary appendectomy in 21 patients, and admission to the hospital for observation before the diagnosis of other conditions by C T in 11 patients. The effects of performing appendiceal CT on the use of hospital resources included the prevention of unnecessary appendect omy in 13 patients (for a savings of $47,281) and the prevention of un necessary hospital admission for 50 patient-days (for a savings of $20 ,250). After the cost of 100 appendiceal CT studies ($22,800) was subt racted, the overall savings was $447 per patient. Conclusions Routine appendiceal CT performed in patients who present with suspected append icitis improves patient care and reduces the use of hospital resources . (C) 1998, Massachusetts Medical Society.