Abstract:
BACKGROUND:Computed tomography (CT) is used increasingly to evaluate suspected cases of acute appendicitis (AA) in the emergency department (ED). This prospective study was performed to test the hypothesis that the evaluation of AA by CT in the ED remains suboptimal and that erroneous interpretation diminishes its utility. METHODS:Consecutive patients 18 years of age or older were enrolled prospectively if AA was among the first three differential diagnoses listed in the record of patients undergoing evaluation of abdominal pain in the ED. Imaging of the abdomen and pelvis was obtained at the discretion of the ED staff or consultant surgeon. Initial CT interpretation was by a radiology resident or fellow along with the surgical staff, but final review by an attending radiologist occurred later. Age, gender, presenting symptoms, white blood cell (WBC) count, final CT results, and final pathology (for patients undergoing operation) were recorded. X +/- SEM, p < 0.05 by chi(2), ANOVA, or MANOVA was used for statistical analysis as appropriate. RESULTS:A CT scan was performed in 104 patients (83% of those meeting entry criteria), 35 of whom were male (mean age, 37 +/- 2 years) and 69 of whom were female (mean age, 39 +/- 3 years). Thirty-five patients had pathologically proved appendicitis, 28 of whom were diagnosed prospectively by CT. There were seven false-negative scans. Sensitivity, specificity, and positive predictive value for the initial CT reading were 80%, 91%, and 82%, respectively. Gender (p < 0.03), WBC count (p < 0.0002), and a positive initial CT reading (p < 0.0001) correlated with operative management. However, although final CT interpretation did correlate with pathologic confirmation of AA (p < 0.0001), initial CT interpretation did not correlate with the presence of AA (p = 0.52). CONCLUSION:The ability of CT to predict AA is dependent on the interpretative skill of the individual interpreting the images. Widespread use of CT in the evaluation of patients for AA should be implemented with caution until institution-specific protocols are validated.
journal_name
Surg Infect (Larchmt)journal_title
Surgical infectionsauthors
Maluccio MA,Covey AM,Weyant MJ,Eachempati SR,Hydo LJ,Barie PSdoi
10.1089/109629601317202687subject
Has Abstractpub_date
2001-10-01 00:00:00pages
205-11; discussion 211-4issue
3eissn
1096-2964issn
1557-8674journal_volume
2pub_type
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pub_type: 杂志文章,多中心研究
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abstract:BACKGROUND:Surgical site infections are the third most common healthcare-associated infection, often leading to prolonged hospital stay and excessive expenditures. Management of these infections has become more challenging due to rising rates of multi-drug-resistant organisms and few new antibiotic options. METHODS:Th...
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更新日期:2011-04-01 00:00:00
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abstract:BACKGROUND:Vancomycin is the mainstay of treatment for methicillin-resistant Staphylococcus aureus (MRSA) meningitis. However, successful outcomes with linezolid have not been reported in a large series of patients. We conducted a single-center retrospective cohort study to compare vancomycin with linezolid in the trea...
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更新日期:2006-04-01 00:00:00
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更新日期:2014-06-01 00:00:00
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