Emergency computed tomography for the diagnosis of acute appendicitis: How effectively we use it?

BACKGROUND: Technological developments support using ultrasonography (US) in all patients, if available, and advanced diagnostic methods such as abdominal computed tomography (CT) in case of clinical suspicion during diagnostic process of acute appendicitis. We aimed to investigate whether CT was appropriately and efficiently used in the diagnosis of acute appendicitis.
METHODS: Between May 2013 and February 2016, 811 patients who underwent appendectomy were retrospectively reviewed from an IRB-approved database, and those who underwent a preoperative CT were enrolled into the study. Results of Alvarado scores and US were recorded in addition to which clinic requested the CT (general surgery or emergency department).
RESULTS: The frequency of CT use in the diagnostic process was 25% (n=208/811). Ultrasound was negative for appendicitis in 53% of these patients. The mean Alvarado score was 5±1.5 (range: 3–8). General surgeons requested 57% of CTs. Alvarado scores were significantly higher in patients whose CT was requested by general surgery than in those whose CT was requested by the emergency clinic (5.6 vs. 4.7, p=0.013). Regarding histopathological results, age and Alvarado scores were significantly lower (p=0.015 and 0.037, respectively), whereas the frequency of negative CT was significantly higher (p=0.042) in those with negative appendectomy (n=29, 14%).
CONCLUSION: Most patients who underwent CT in the diagnostic process had an Alvarado score between 5 and 8 and negative ultrasound for appendicitis preoperatively. These findings may provide efficient use of CT in the diagnosis of appendicitis with an acceptable rate of 25% compared with the findings in current literature. However, further research is needed to ensure more efficient use of CT because negative appendectomy has been a concern in our series despite promising results of this study.

Akut apandisit tanýsýnda bilgisayarlý tomografi ne kadar etkili kullanýlýyor?

AMAÇ: Geliþen teknolojik imkanlar ve bunlara kolay ulaþým ile birlikte akut apandisit hastalarýnýn tanýsýnda hemen her hastada kullanýlan ultrasonografi (USG) -özellikle klinik þüphede kalýnan hastalarda- bilgisayarlý tomografi (BT) ile desteklenmektedir. Biz bu çalýþmada özellikle Alvarado skorlamasý ve US sonuçlarý göz önüne alýnarak akut apandisit tanýsýnda kullanýlan BT’nin ne kadar etkin kullanýldýðýný araþtýrmayý hedefledik.
GEREÇ VE YÖNTEM: Mayýs 2013 ve Þubat 2016 tarihleri arasýnda acil serviste deðerlendirilerek tedavisi düzenlenen akut apandisit hastalarý etik kurul onaylý veriler analiz edilerek geriye dönük tarandý. Ameliyat öncesi BT kullanýlan hastalar çalýþmaya alýndý. Hastalarýn demografi verileri, Alvarado skorlarý, USG ve BT raporlarý, BT istenen bölüm (acil servis-cerrahi), ameliyat notlarý ve patoloji sonuçlarý kayýt edildi.
BULGULAR: Çalýþma sürecinde tedavi edilen 811 akut apandisit hastasýndan 208’ine (%25) BT çekildiði saptandý. Hastalarýn hepsine en az bir kez USG yapýlmýþtý ve %53’ünde (n=112) USG negatif idi. Alvarado skorlarý ortalama 5±1.5 (daðýlým: 3–8) idi. Bilgisayarlý tomografi istemlerinin %42’si acil hekimleri tarafýndan %57’si cerrahlar tarafýndan istenmiþti. Acil servis ve cerrahi branþlarýnýn BT istemi yaptýklarý hastalarýn ortalama Alvarado skorlarý sýrasýyla 4.7 ve 5.6 olarak bulundu (p=0.013). Apendiks patolojisi normal saptanan (n=29, %14) hastalarda negatif BT oraný anlamlý yüksek (p=0.042); yaþ ve Alvarado skoru anlamlý düþük (sýrasýyla, p=0.015 ve 0.037) saptandý.
TARTIÞMA: Alvarado skorunun BT çekilen hastalarýn çoðunda 5–8 arasýnda olmasý ve çoðunlukla USG negatif hastalarda olmak üzere %25 oranýnda uygulanmasý ameliyat öncesi BT’nin apandisit tanýsýnda etkin kullanýldýðý lehine yorumlanabilir. Bu sonuçlar ýþýðýnda çalýþmamýzdaki negatif apendektomi oranlarý göz önüne alýndýðýnda BT’nin daha etkin kullanýmýný saðlamak için ileri çalýþmalara ihtiyaç vardýr.