CT Scans Alter ER Decision-Making About Appendicitis
Data collected from CT scanning of the abdomen and pelvis can alter decision-making by clinicians regarding those patients who are suspected of having appendicitis. A research study evaluating such was recently published in the American Journal of Roentgenology.
The study was completed at the University of Washington Harborview Medical Center in Seattle. The research team examined 100 patients who presented to the emergency room with symptoms of appendicitis. All patients underwent CT scanning.
The researchers compared clinical plans both before and after CT was completed, as well as likelihood of appendicitis. The primary question of interest was whether or not results from the CT changed treatment plans. A second endpoint of interest was the accuracy of CT.
In 29 percent of the patients, data from the CTs changed a planned treatment approach. In half of the cases where suspicion for appendicitis was high, findings ruled out appendicitis as the cause of symptoms. In all of the patients with unlikely appendicitis, disease was ruled out with CT.
The UW team compared characteristics of CT scanning for this diagnosis in the emergency room setting. Sensitivity was 94 percent and specificity was 100 percent. Positive predictive value was 100 percent and negative predictive value was 99 percent. Accuracy, too, was marked at 99 percent.
The team highlighted the limited value of CT scanning. Data from CTs was most useful in those cases when data strongly suggest that patients had appendicitis. In those patients where data was less convincing, CT may not be meaningful.
October 8, 2008 Related topics: Diagnostic, Surgery, Emergency