medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2011, Number 4

<< Back Next >>

Cir Gen 2011; 33 (4)

Negative appendectomies and their relation with imaging studies

López MJC, Martínez CA, Zamarrón RA, Rodríguez GK

Language: Spanish
References: 18
Page: 222-226
PDF size: 63.22 Kb.


ABSTRACT

Objective: To identify whether diagnostic imaging, such as computed axial tomography (CAT) and ultrasonography (US) can be associated with a lower incidence of negative appendectomies.
Setting: Hospital Christus Muguerza del Parque, private third level health care hospital.
Design: Diagnostic test, retrospective, descriptive, observational, cross-sectional study.
Statistical analysis: Sensitivity, specificity, predictive values, and Bayesian testing.
Patients and methods: All patients subjected to appendectomy in the period from January 2006 to December 2008 were included in the study. The histopathological report, as diagnostic gold standard, was correlated with the imaging studies, CAT und US, in patients with clinical symptoms suggestive of acute appendicitis.
Results: We included 207 patients, 107 were men (52%) and 100 women (48%). In 183 patients (88.4%) subjected to appendectomy, the histopathological diagnosis of acute appendicitis was confirmed, whereas the remainder 24 patients (11.6%) had negative appendectomies, these corresponded to 10 men and 14 women. During the study period, the frequency of negative appendectomies decreased 66% in 2008 with respect to 2007, concurrently the use of CAT to assess these cases increased 41%. CAT presented a sensitivity of 89%, specificity of 60%, positive predictive value (PPV) of 94.8% and negative predictive value (NPV) of 40%, the possibility of negative post-test (PNPT) was of 59.9%. US had a sensitivity of 63%, specificity of 40%, PPV of 85.5% and NPV of 15.8%, and PNPT of 84.2%.
Conclusions: Neither the increase in the use of CAT with IV contrast medium nor of US was associated with a lower incidence of negative appendectomies. The clinical criterion remains being valid.


REFERENCES

  1. Morse BC, Roettger RH, Kalbaugh CA, Blackhurst DW, Hines WB Jr. Abdominal CT scanning in reproductive-age women with right lower quadrant abdominal pain: does its use reduce negative appendectomy rates and healthcare costs? Am Surg 2007; 73: 580-584.

  2. McGory ML, Zingmond DS, Nanayakkara D, Maggard MA, Ko CY. Negative appendectomy rate: influence of CT scans. Am Surg 2005; 71: 803-808.

  3. Jones K, Peña Alberto, Dunn EL, Nadalo L, Mangram AJ. Are negative appendectomies still acceptable? Am J Surg 2004; 188: 748-754.

  4. Flum DR, McClure TD, Morris A, Koepsell T. Misdiagnosis of appendicitis and the use of diagnostic imaging. J Am Coll Surg 2005; 201: 933-939.

  5. Prystowsky JB, Pugh CM, Agle AP. Current problems in surgery. Appendicitis. Curr Probl Surg 2005; 42: 688-742.

  6. 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. New Engl J Med 1998; 338: 141-146.

  7. 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: 440-446.

  8. García-Aguayo FJ, Gil P. Sonography in acute appendicitis: diagnostic utility and influence upon management and outcome. Eur Radiol 2000; 10: 1886-1893.

  9. McDonald GP, Pendarvis DP, Wilmoth R, Daley BJ. Influence of preoperative computed tomography on patients undergoing appendectomy. Am Surg 2001; 11: 1017-1021.

  10. van Breda Vriesman AC, Kole BJ, Puylaert JB. Effect of ultrasonography and optional computed tomography on the outcome of appendectomy. Eur Radiol 2003; 13: 2278-2282.

  11. Antevil J, Rivera L, Langenberg B, Brown CV. The influence of age and gender on the utility of computed tomography to diagnose acute appendicitis. Am Surg 2004; 70: 850-853.

  12. Hernández JA, Swischuk LE, Ángel CA, Chung D, Chandler R, Lee S. Imaging of acute appendicitis: US as the primary imaging modality. Pediatr Radiol 2005; 35: 392-395.

  13. Petrosyan M, Estrada J, Chan S, Somers S, Yacoub WN, Kelso RL et al. CT scan in patients with suspected appendicitis: clinical implications for the acute care surgeon. Eur Surg Res 2008; 40: 211-219.

  14. Iwahashi N, Kitagawa Y, Mayumi T, Kohno H. Intravenous contrast-enhanced computed tomography in the diagnosis of acute appendicitis. World J Surg 2005; 29: 83-87.

  15. Johansson EP, Rydh A, Riklund KA. Ultrasound, computed tomography, and laboratory findings in the diagnosis of appendicitis. Acta Radiol 2007; 48: 267-273.

  16. López PP, Cohn SM, Popkin CA, Jackowski J, Michalek JE. Appendicitis diagnostic group. The use of a computed tomography scan to rule out appendicitis in women of childbearing age is as accurate as clinical examination: a prospective randomized trial. Am Surg 2007; 73: 1232-1236.

  17. Cho CS, Buckingham JM, Pierce M, Hardman DT. Computed tomography in the diagnosis of equivocal appendicitis. Aust N Z J Surg 1999; 69: 664-667.

  18. Huynh V, Lalezarzadeh F, Lawandy S, Wong DT, Joe VC. Abdominal computed tomography in the evaluation of acute and perforated appendicitis in the community setting. Am Surg 2007; 73: 1002-1005.




2020     |     www.medigraphic.com