W. Boyan1, A. Dinallo1, B. Protyniak1, M. Farr2, M. Goldfarb1 1Monmouth Medical Center,Surgery,Long Branch, NJ, USA 2Saint George’s University,Grenada, Grenada, Grenada
Introduction: Historically, acute appendicitis has been a clinical diagnosis made primarily on the basis of history and physical findings. The typical history is onset of abdominal pain followed by anorexia and nausea. Physical exam findings include right lower quadrant tenderness. Using solely clinical and laboratory variables, the rate of negative appendectomies has been approximately 20%. With the advent of the high resolution multi-slice computed tomography (CT), the aforementioned rate is now reported to be 6-13%. However, this has led to a liberal use of imaging regardless of a convincing clinical exam. The implications of additional radiation exposure are still unclear. We sought to quantify the number of CTs obtained for patients with suspected acute appendicitis and to identify the ordering physician group.
Methods: This is a single institution retrospective chart review of all patients presenting to the emergency department with a working diagnosis of acute appendicitis between January 2011 and December 2012. Patient demographics, history of presenting illness, physical exam, whether or not a CT was obtained, and CT ordering physician were identified. CT ordering physicians were grouped into three categories: emergency medicine, surgery, and primary care. All positive CT findings were confirmed by final pathology.
Results: Two thousand five hundred patients comprised the study group. A CT was obtained in 2400 patients (96%), confirming acute appendicitis in 440 (18%). CT findings other than acute appendicitis were responsible for abdominal pain in 200 patients (8%). One thousand seven hundred and sixty patients (73%) with a negative CT for appendicitis were either discharged or admitted for supportive care. Emergency medicine physicians accounted for the majority (75%) of those ordering CT scans.
Conclusion: Emergency medicine physicians, primary care practitioners and even surgeons have become dependent on CT scanning to diagnose acute appendicitis. Recent literature states that diagnostic imaging can significantly increase an individual’s risk of developing cancer. The majority of patients in our study with a suspected diagnosis of appendicitis underwent a CT scan and did not have appendicitis. Although CT scans may prevent unnecessary surgery, their liberal use has potentially worrisome implications of developing future malignancy