Computed Tomography and Ultrasonography Do Not Improve and May Delay the Diagnosis and Treatment of Acute Appendicitis

Abstract

ALTHOUGH the treatment of acute appendicitis is simple and straightforward, its diagnosis remains a challenge, and the negative appendectomy rate in large series ranges from 15% to 33%.^1-5 Furthermore, in the patients with either atypical history or equivocal physical examination findings, particularly in women of childbearing age, the negative appendectomy rate has been as high as 45%.⁴ With an annual rate of 250 000 cases in the US and an incidence of 86 for every 100 000 persons worldwide,^6,7 acute appendicitis is a common acute abdomen condition in the emergency department (ED). During the last decade, studies of white blood cell scan, ultrasonography (US), and computed tomographic (CT) scan have suggested that these diagnostic imaging modalities may improve the diagnostic accuracy for acute appendicitis.^8-11 On the other hand, there were also concerns about the appropriateness and accuracy of these modalities without a surgical evaluation.^10,11