Evaluation for suspected acute appendicitis in the emergency department setting: a comparison of outcomes among three imaging pathways

Clin Imaging. 2016 Jul-Aug;40(4):788-92. doi: 10.1016/j.clinimag.2016.02.022. Epub 2016 Feb 26.

Abstract

Purpose: To compare outcomes of imaging pathways in suspected acute appendicitis.

Methods: Computerized tomography (CT) alone, ultrasound alone, and ultrasound followed by CT were compared in 570 emergency department (ED) patients with suspected acute appendicitis.

Results: After initial ultrasound, 9.3% of men and 41.0% of women underwent CT. Body mass index (BMI) (P≤.036): 25.3±5.7kg/m(2) (CT), 19.1±3.3kg/m(2) (ultrasound), and 22.4±3.2kg/m(2) (ultrasound then CT). Age (P<.001): 35.9±14.5 years (CT), 12.8±6.2y (ultrasound), and 21.2±9.0 years (ultrasound then CT). ED length-of-stay: 7.0±2.8h (CT), 5.9±2.8h (ultrasound), and 8.4±3.5h (ultrasound then CT). Admission, same-day discharge, appendectomy, pathology positive for appendicitis or complicated appendicitis, 30-day repeat ED visit/hospitalization: no difference between pathways (P=.062-1.00).

Conclusion: Ultrasound, selected in patients with lowest age/BMI, had shortest length-of-stay but otherwise similar outcomes.

Keywords: Acute appendicitis; CT; Emergency radiology; Outcomes; Ultrasound.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Appendectomy
  • Appendicitis / diagnostic imaging*
  • Appendicitis / surgery
  • Appendix / diagnostic imaging
  • Body Mass Index
  • Child
  • Child, Preschool
  • Emergency Service, Hospital*
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Reproducibility of Results
  • Retrospective Studies
  • Tomography, X-Ray Computed*
  • Ultrasonography*
  • Young Adult