The Journal of Emergency Medicine
Volume 23, Issue 1 , Pages 1-7, July 2002

Unenhanced helical CT scanning of the abdomen and pelvis changes disposition of patients presenting to the emergency department with possible acute appendicitis1

Presented in Abstract Form at the American Academy of Emergency Medicine 3rd Annual Resident Research Forum, Orlando, Florida, February 2001 (First Place). Presented in Abstract Form at the Society of Air Force Clinical Surgeons Annual Meeting, San Antonio, Texas, March 2001 (Surgeon General’s Award).

  • Frank L Christopher, MD

      Affiliations

    • Corresponding Author InformationCorrespondence Address: MAJ Frank L. Christopher, Department of Emergency Medicine, Womack Army Medical Center, ATTN: MCXE-EM, Reilly Road, Fort Bragg, North Carolina 28310, USA
    • Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
    • ,
  • Michael J Lane, MD

      Affiliations

    • Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
    • ,
  • John A Ward, PhD

      Affiliations

    • Department of Clinical Investigation, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
    • ,
  • J.Alan Morgan (DO)

      Affiliations

    • Department of Combat Medic Training, U. S. Army Medical Department Center and School, Fort Sam Houston, Texas, USA

Received 16 March 2001; received in revised form 22 October 2001; accepted 27 November 2001.

Abstract 

This study sought to determine if obtaining an unenhanced abdominopelvic computed tomography (UHCT) scan alters the disposition of patients presenting to the Emergency Department (ED) with signs and symptoms of acute appendicitis. A convenience sample of 101 patients presenting with a clinical picture suggestive of appendicitis were prospectively enrolled. Emergency physicians (EPs) and general surgeons independently recorded their anticipated disposition of each patient as: discharge, admit for observation, or admit for appendectomy. A UHCT scan was then obtained and the patient’s ultimate disposition recorded. EPs altered their dispositions after UHCT scanning in 35 patients (34.7%, 95% CI 25.4% to 44.0%), and general surgeons altered their dispositions in 27 patients (26.7%, 95% CI 18.1% to 35.3%). More patients underwent operative intervention than were originally selected by EPs [14 additional patients, (13.9%, 95% CI 7.1% to 20.6%)] or by surgeons [20 additional patients, (19.8%, 95% CI 12.0% to 27.6%)]. CT scan revealed alternative diagnoses in 20 patients (19.8%). UHCT scanning significantly alters patient disposition, and significantly increases the number of operative interventions performed in patients with suspected appendicitis. UHCT scanning may also identify alternate pathology that clinically mimics appendicitis.

Keywords:  appendicitis, computed tomography, CT scan, diagnosis, disposition

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  • 1 Original Contributions is coordinated by John A. Marx, MD, of Carolinas Medical Center, Charlotte, North Carolina

PII: S0736-4679(02)00453-5

The Journal of Emergency Medicine
Volume 23, Issue 1 , Pages 1-7, July 2002

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