Diagnostic Performance of Surgical Criteria Incorporating MDCT for Suspected Acute Appendicitis

Abstract

Objective The objective of this study was to evaluate the effectiveness of a new set of criteria and multidetector computed tomography (MDCT) in determining whether surgical intervention is required in cases of appendicitis, with the aim of reducing unnecessary procedures and postoperative complications. Methods The patients were divided into 2 groups: group A, comprising patients who were admitted between 2008 and 2013 and treated based on the new criteria; and group B, comprising patients who were admitted between 2003 and 2007 and treated based on the standard criteria. Positive and negative predictive values were calculated. Results Of 1021 patients, 533 (274 males, 259 females) belonged to group A and 488 (263 males, 225 females) to group B. Surgical procedures were performed in 46.0% (245 cases) of patients in group A and 64.3% (314 cases) in group B (P > 0.001). The rate of conservative treatment was significantly higher in group A. The overall rate of catarrhal appendicitis based on histopathologic findings was 6.9% (17 cases) in group A and 15.0% (47 cases) in group B (P > 0.003). The overall rate of surgical complications was significantly higher in group B, being observed in 14.6% (46 cases) in this group, but only 8.2% (20 cases) in group A (P > 0.02). No statistically significant difference was observed in rate of conversion to surgery after conservative therapy or recurrence between the 2 groups. Conclusion Our new surgical criteria incorporating MDCT are effective in reducing the incidence of negative appendectomies and surgical complications.