Routine ultrasound and limited computed tomography for the diagnosis of acute appendicitis

World J Surg. 2010 Oct;34(10):2278-85. doi: 10.1007/s00268-010-0694-y.


Background: Acute appendicitis continues to be a challenging diagnosis. Preoperative radiological imaging using ultrasound (US) or computed tomography (CT) has gained popularity as it may offer a more accurate diagnosis than classic clinical evaluation. The optimal implementation of these diagnostic modalities has yet to be established. The aim of the present study was to investigate a diagnostic pathway that uses routine US, limited CT, and clinical re-evaluation for patients with acute appendicitis.

Methods: A prospective analysis was performed of all patients presenting with acute abdominal pain at the emergency department from June 2005 until July 2006 using a structured diagnosis and management flowchart. Daily practice was mimicked, while ensuring a valid assessment of clinical and radiological diagnostic accuracies and the effect they had on patient management.

Results: A total of 802 patients were included in this analysis. Additional radiological imaging was performed in 96.3% of patients with suspected appendicitis (n = 164). Use of CT was kept to a minimum (17.9%), with a US:CT ratio of approximately 6:1. Positive and negative predictive values for the clinical diagnosis of appendicitis were 63 and 98%, respectively; for US 94 and 97%, respectively; and for CT 100 and 100%, respectively. The negative appendicitis rate was 3.3%, the perforation rate was 23.5%, and the missed perforated appendicitis rate was 3.4%. No (diagnostic) laparoscopies were performed.

Conclusions: A diagnostic pathway using routine US, limited CT, and clinical re-evaluation for patients with acute abdominal pain can provide excellent results for the diagnosis and treatment of appendicitis.

Publication types

  • Clinical Trial

MeSH terms

  • Abdominal Pain / diagnostic imaging
  • Abdominal Pain / surgery
  • Acute Disease
  • Adolescent
  • Adult
  • Appendectomy
  • Appendicitis / diagnostic imaging*
  • Appendicitis / surgery
  • Child
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Tomography, X-Ray Computed
  • Ultrasonography
  • Young Adult