IS THERE A ROLE FOR ABDOMINAL COMPUTED TOMOGRAPHIC SCANS IN APPENDICITIS

Objective: To better define the effectiveness of abdominal computed to mographic scanning (ACTS) in adult patients with suspected appendiciti s. Design: Retrospective analysis. Setting: A community teaching hospi tal. Patients: Ninety-seven patients with appendicitis in the differen tial diagnosis, whose clinical findings were insufficient to perform s urgery or to discharge from the hospital, during a 14-month period. In terventions: None. Main Outcome Measures: Accuracy of ACTS, rate of ap pendectomies that show no appendicitis (negative appendectomy rate), a nd frequency of ACTS as a definitive diagnostic test. Results: Forty-n ine of the 50 patients with appendicitis were correctly diagnosed by A CTS. Forty-three of the 47 patients without appendicitis were correctl y diagnosed by ACTS. Positive predictive value was 92%, negative predi ctive value was 98%, and accuracy was 96%. The ACTS group had a negati ve appendectomy rate of 5.8% (3/52), lower than the hospital rate of 1 4% for the preceding 3 years. The ACTS established an alternative diag nosis in 16 patients, allowed 10 other patients to be discharged early or not admitted, and was the critical diagnostic test in 30 of the pa tients with appendicitis. Therefore, the ACTS played a definitive role in the treatment of 56 (57.7%) of the 97 patients. Conclusions: The A CTS was an accurate test in the diagnosis of appendicitis and was of s ignificant benefit in 57.7% of the patients studied. However, it was d ifficult to predict which patients were most likely to benefit. Expand ed selective use of ACTS for patients with clinically indeterminate ap pendicitis may result in a lower negative appendectomy rate and fewer patient admissions for observation.