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 ,Revised 22 October 2001 ,Accepted 27 November 2001.

References 

  1. Fitz RH. Perforating inflammation of the vermiform appendix with special reference to its early diagnosis and treatment. Trans Assoc Am Physicians. 1886;1:107–144
  2. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132:910–925
  3. Hoffmann J, Rasmussen OØ. Aids in the diagnosis of acute appendicitis. Br J Surg. 1989;76:774–779
  4. Hale DA, Molloy M, Pearl RH, Schutt DC, Jaques DP. Appendectomy (a contemporary appraisal). Ann Surg. 1997;3:252–261
  5. Fedyshin P, Kelvin FM, Rice RP. Nonspecificity of barium enema findings in acute appendicitis. Am J Roentgenol. 1984;143:99–102
  6. Sarfati MR, Hunter GC, Witzke DB, et al.  Impact of adjunctive testing on the diagnosis and clinical course of patients with acute appendicitis. Am J Surg. 1993;166:6:660–6:665
  7. Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C. Acute appendicitis (CT and US confirmation in 100 patients). Radiology. 1994;190:31–35
  8. Siewert B, Raptopoulos V, Mueller MF, Rosen MP, Steer M. Impact of CT on diagnosis and management of acute abdomen in patients initially treated without surgery. Am J Roentgenol. 1997;168:173–178
  9. Schuler JG, Shortsleeve MJ, Goldenson RS, Perez-Rossello JM, Perlmutter RA, Thorsen A. Is there a role for abdominal computed tomographic scans in appendicitis?. Arch Surg. 1998;133:4:373–4:377
  10. Balthazar EJ, Megibow AJ, Siegel SE, Birmbaum BA. Appendicitis (prospective evaluation with high-resolution CT). Radiology. 1991;180:21–24
  11. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med. 1998;338:141–146
  12. Stroman DL, Bayouth CV, Kuhn JA, et al.  The role of computed tomography in the diagnosis of acute appendicitis. Am J Surg. 1999;178:6:485–6:489
  13. Malone AJ, Wolf CR, Malmed AS, Melliere BF. Diagnosis of acute appendicitis (value of unenhanced CT). Am J Roentgenol. 1993;160:763–766
  14. Lane MJ, Katz DS, Ross BA, Clautice-Engle TL, Mindelzun RE, Jeffrey RB. Unenhanced helical CT for suspected acute appendicitis. Am J Roentgenol. 1997;168:405–409
  15. Lane MJ, Liu DM, Huynh MD, Jeffrey RB, Mindelzun RE, Katz DS. Suspected acute appendicitis (nonenhanced helical CT in 300 consecutive patients). Radiology. 1999;213:341–346
  16. Mindelzun RE, Jeffrey RB. Unenhanced helical CT for evaluating acute abdominal pain (a little more cost, a lot more information). Radiology. 1997;205:43–47
  17. Lane MJ, Mindelzun RE. Appendicitis and its mimickers. Semin Ultrasound CT MR. 1999;20:77–85
  18. Malone AJ. Unenhanced CT in the evaluation of the acute abdomen (the community hospital experience). Semin Ultrasound CT MR. 1999;20:68–76
  19. Rhea JT, Rao PM, Novelline RA, McCabe CJ. A focused appendiceal CT technique to reduce the cost of caring for patients with clinically suspected appendicitis. Am J Roentgenol. 1997;169:113–118
  20. Garcia Peña BM, Taylor GA, Lund DP, Mandl KD. Effect of computed tomography on patient management and costs in children with suspected appendicitis. Pediatrics. 1999;104:3:440–3:446
  21. Von Titte SN, McCabe CJ, Ottinger LW. Delayed appendectomy for appendicitis (causes and consequences). Am J Emerg Med. 1996;14:620–622
  22. Rusnak RA, Borrer JM, Fastow JS. Mis-diagnosis of acute appendicitis (common features discovered in cases after litigation). Am J Emerg Med. 1994;12:397–402
  23. Jess P, Bjerregaard B, Brynitz S, Holst-Christensen J, Kalaja E, Lund-Kristensen J. Acute appendicitis (prospective trial concerning diagnostic accuracy and complications). Am J Surg. 1981;141:232–234
  24. Irvin TT. Abdominal pain (a surgical audit of 1190 emergency admissions). Br J Surg. 1989;76:1121–1125
  25. Bergeron E, Richer B, Gharib R, Giard A. Appendicitis is a place for clinical judgement. Am J Surg. 1999;177:460–462
  26. Wilcox RT, Traverso LW. Have the evaluation and treatment of acute appendicitis changed with new technology?. Surg Clin North Am. 1997;77:6:1355–6:1370
  27. Weyant MJ, Eachempati SR, Maluccio MA, et al.  Interpretation of computed tomography does not correlate with laboratory or pathologic findings in surgically confirmed acute appendicitis. Surgery. 2000;128:145–152
  28. Baigrie RJ, Dehn TCB, Fowler SM, Dunn DC. Analysis of 8651 appendicectomies in England and Wales during 1992. Br J Surg. 1995;82:933
  29. Temple CL, Huchcroft SA, Temple WJ. The natural history of appendicitis in adults (a prospective study). Ann Surg. 1995;221:3:278–3:281
  30. Hale DA, Jaques DP, Molloy M, Pearl RH, Schutt DC, d’Avis JC. Appendectomy (improving care through quality improvement). Arch Surg. 1997;132:153–157
  31. Eldar S, Nash E, Sabo E, et al.  Delay of surgery in acute appendicitis. Am J Surg. 1997;173:194–198
  32. Colson M, Skinner KA, Dunnington G. High negative appendectomy rates are no longer acceptable. Am J Surg. 1997;174:723–727
  33. Horton MD, Counter SF, Florence MG, Hart MJ. A prospective trial of computed tomography and ultrasonography for diagnosing appendicitis in the atypical patient. Am J Surg. 2000;179:379–381
  34. Graffeo CS, Counselman FL. Appendicitis. Emerg Med Clin North Am. 1996;14:4:653–4:672
  35. Cappendijk VC, Hazebroek FWJ. The impact of diagnostic delay on the course of acute appendicitis. Arch Dis Child. 2000;83:64–66
  36. Savrin RA, Clatworthy HW. Appendiceal rupture. Pediatrics. 1979;63:37–43
  37. Scher KS, Coil JA. The continuing challenge of perforating appendicitis. Surg Gynecol Obstet. 1980;150:535–538

PII: S0736-4679(02)00453-5

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

Article Tools