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Rare but Significant Problems Associated With CT Scans in the Diagnosis of Appendicitis
Lily Saadat2, David M. Mahvi1, Irene Helenowski1, Anne Marie Boller*1
1Surgery, Northwestern Memorial Hospital, Chicago, IL; 2Northwestern Feinberg School of Medicine, Chicago, IL
Background:
Acute appendicitis is one of the most common surgical emergencies. There is no standardized diagnostic approach to the disease. Our study evaluated all patients given the diagnosis of appendicitis and reviewed their diagnostic workup and clinical outcomes.
Patients and Methods:
We retrospectively reviewed all adult patients given an ICD-9 code for appendicitis at a single institution between January 2000 and September 2010. Complication rates, time to the operating room (OR) and length of hospital stay (LOS) were compared between patients who received a CT scan and those who did not during the hospitalization for appendicitis.
Results:
Three thousand six hundred and ninety-seven patients were identified by ICD-9 code. Three thousand and seventy patients underwent appendectomy, with 2840 patients having a preoperative CT scan and 430 patients without a CT scan. Average time from Emergency Department (ED) to the OR was found to be statistically longer for patients who underwent a CT scan (10 hrs: 3, 1548) versus those who did not have a CT (6 hrs: 2, 262) (p < 0.0001). We evaluated the cohort for postoperative complications, specifically the pulmonary diagnoses of pneumonia and ARDS. There were 19 patients who had the complication of pneumonia and 4 patients who were diagnosed with ARDS. Patients who underwent a CT scan had a statistically higher number of both complications (p<0.0001). Sixteen of the 19 patients with pneumonia had CT scans. Fifteen of the 16 patients (93.75%) had been given oral contrast; this was found to be statistically significant (p <0.0001). All cases of ARDS occurred in patients who had CT scans, and all four ARDS patients received oral contrast. While the LOS was not statistically different between the CT and non-CT cohorts, there was a significant difference in length of stay when the cohort was divided by the presence or absence of the complication pneumonia. Patients with pneumonia after their appendectomy had a median LOS of 7 days (1, 57) as opposed to appendectomy patients without pneumonia whose median LOS was 1 day (1, 109) (p<0.0001).
Conclusions:
The diagnosis of acute appendicitis is nearly universally accompanied by a CT scan. The utility of this diagnostic modality is undeniable. The use of oral contrast is not necessary for an accurate diagnosis of appendicitis and may be associated with higher complication rates, longer hospital stays and poor outcomes.
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