Abstract
(1) Background: Diagnosis of acute appendicitis (AA) remains challenging; either computed tomography (CT) is universally used or negative appendectomy rates of up to 30% are reported. Transabdominal ultrasound (TUS) as the first-choice imaging modality might be useful in adult patients to reduce the need for CT scans while maintaining low negative appendectomy (NA) rates. The aim of this study was to report the results of the conditional CT strategy for the diagnosis of acute appendicitis. (2) Methods: All patients suspected of acute appendicitis were prospectively registered from 1 January 2016 to 31 December 2018. Data on their clinical, radiological and surgical outcomes are presented. (3) Results: A total of 1855 patients were enrolled in our study: 1206 (65.0%) were women, 649 (35.0%) were men, and the median age was 34 years (IQR, 24.5–51). TUS was performed in 1851 (99.8%) patients, and CT in 463 (25.0%) patients. Appendices were not visualized on TUS in 1320 patients (71.3%). Furthermore, 172 (37.1%) of 463 CTs were diagnosed with AA, 42 (9.1%) CTs revealed alternative emergency diagnosis and 249 (53.8%) CTs were normal. Overall, 519 (28.0%) patients were diagnosed with AA: 464 appendectomies and 27 diagnostic laparoscopies were performed. The NA rate was 4.2%. The sensitivity and specificity for TUS and CT are as follows: 71.4% and 96.2%; 93.8% and 93.6%. (4) Conclusion: A conditional CT strategy is effective in reducing NA rates and avoids unnecessary CT in a large proportion of patients. Observation and repeated TUS might be useful in unclear cases.
Highlights
Acute appendicitis (AA) is one of the most common causes of urgent surgery, and appendectomy, the gold standard for AA treatment, is the most frequently performed emergency surgery [1]. Even though it has been centuries since AA was described for the first time by James Parkinson in 1812, diagnostics remain challenging, and the negative appendectomy rate can still be as high as 30% due to similarities to other common causes of abdominal pain [2,3,4]
If the appendix was visualized on Transabdominal ultrasound (TUS) it was classified into the following groups: Normal appendix: diameter of appendix
A total of 1855 patients were included in the study (Figure 1): 1206 (65.0%) were women, 649 (35.0%) were men, with a median age of 34 years (IQR, 24.5–51)
Summary
Acute appendicitis (AA) is one of the most common causes of urgent surgery, and appendectomy, the gold standard for AA treatment, is the most frequently performed emergency surgery [1]. Even though it has been centuries since AA was described for the first time by James Parkinson in 1812, diagnostics remain challenging, and the negative appendectomy rate can still be as high as 30% due to similarities to other common causes of abdominal pain [2,3,4]. Clinical and laboratory scores—Alvarado score, Appendicitis Inflammatory Response score (AIR), Paediatric Appendicitis Score (PAS) and others—were designed to improve the diagnostic accuracy. CT is more expensive and uses ionizing radiation, which should be avoided in pregnant women, children and young adult populations [4,7]
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