Enteral contrast in the computed tomography diagnosis of appendicitis: comparative effectiveness in a prospective surgical cohort.


OBJECTIVE:Our goal was to perform a comparative effectiveness study of intravenous (IV)-only versus IV + enteral contrast in computed tomographic (CT) scans performed for patients undergoing appendectomy across a diverse group of hospitals. BACKGROUND:Small randomized trials from tertiary centers suggest that enteral contrast does not improve diagnostic performance of CT for suspected appendicitis, but generalizability has not been demonstrated. Eliminating enteral contrast may improve efficiency, patient comfort, and safety. METHODS:We analyzed data for adult patients who underwent nonelective appendectomy at 56 hospitals over a 2-year period. Data were obtained directly from patient charts by trained abstractors. Multivariate logistic regression was utilized to adjust for potential confounding. The main outcome measure was concordance between final radiology interpretation and final pathology report. RESULTS:A total of 9047 adults underwent appendectomy and 8089 (89.4%) underwent CT, 54.1% of these with IV contrast only and 28.5% with IV + enteral contrast. Pathology findings correlated with radiographic findings in 90.0% of patients who received IV + enteral contrast and 90.4% of patients scanned with IV contrast alone. Hospitals were categorized as rural or urban and by their teaching status. Regardless of hospital type, there was no difference in concordance between IV-only and IV + enteral contrast. After adjusting for age, sex, comorbid conditions, weight, hospital type, and perforation, odds ratio of concordance for IV + enteral contrast versus IV contrast alone was 0.95 (95% CI: 0.72-1.25). CONCLUSIONS:Enteral contrast does not improve CT evaluation of appendicitis in patients undergoing appendectomy. These broadly generalizable results from a diverse group of hospitals suggest that enteral contrast can be eliminated in CT scans for suspected appendicitis.


Ann Surg


Annals of surgery


Drake FT,Alfonso R,Bhargava P,Cuevas C,Dighe MK,Florence MG,Johnson MG,Jurkovich GJ,Steele SR,Symons RG,Thirlby RC,Flum DR,Writing Group for SCOAP-CERTAIN.




Has Abstract


2014-08-01 00:00:00












  • Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. A prospective, randomized clinical trial.

    abstract::The hypothesis that optimizing hemodynamics using pulmonary artery (PA) catheter (preoperative 'tune-up') would improve outcome in patients undergoing limb-salvage arterial surgery was tested. Eighty-nine patients were randomized to preoperative tune-up either in the surgical intensive care unit (SICU) (group 1) or th...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Berlauk JF,Abrams JH,Gilmour IJ,O'Connor SR,Knighton DR,Cerra FB

    更新日期:1991-09-01 00:00:00

  • Preoperative and long-term cardiac risk assessment. Predictive value of 23 clinical descriptors, 7 multivariate scoring systems, and quantitative dipyridamole imaging in 360 patients.

    abstract::A total of 360 patients underwent preoperative cardiac risk assessment using 23 clinical parameters, seven multivariate clinical scoring systems, and quantitative dipyridamole-thallium imaging to predict postoperative and long-term myocardial infarction and cardiac death after noncardiac surgery. There were 30 postope...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Lette J,Waters D,Bernier H,Champagne P,Lassonde J,Picard M,Cerino M,Nattel S,Boucher Y,Heyen F

    更新日期:1992-08-01 00:00:00

  • Gastric surgery for morbid obesity. The Adelaide Study.

    abstract::The efficacy of three gastric restriction operations were compared in a prospective randomized study of 310 morbidly obese subjects. The median patient age was 34 years (range, 18 to 62 years). They were predominantly female (13:1) and had a median pre-operative weight that was 198% of their ideal weight (range, 160% ...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Hall JC,Watts JM,O'Brien PE,Dunstan RE,Walsh JF,Slavotinek AH,Elmslie RG

    更新日期:1990-04-01 00:00:00

  • The Influence of Hospital Volume on Circumferential Resection Margin Involvement: Results of the Dutch Surgical Colorectal Audit.

    abstract:UNLABELLED:This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (<20 cases/year) was independently associated with a higher risk of CRM involvement (odds ratio...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Gietelink L,Henneman D,van Leersum NJ,de Noo M,Manusama E,Tanis PJ,Tollenaar RA,Wouters MW,Dutch Surgical Colorectal Cancer Audit Group.

    更新日期:2016-04-01 00:00:00

  • Endoscopic harvesting device type and outcomes in patients undergoing coronary artery bypass surgery.

    abstract:OBJECTIVE:To evaluate angiographic and clinical outcomes associated with open and closed dissection tunnel endoscopic vein harvesting (EVH) devices. BACKGROUND:A previous PREVENT-IV (PRoject of Ex-vivo Vein graft ENgineering via Transfection IV) analysis reported that EVH for coronary artery bypass graft surgery was a...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: van Diepen S,Brennan JM,Hafley GE,Reyes EM,Allen KB,Ferguson TB,Peterson ED,Williams JB,Gibson CM,Mack MJ,Kouchoukos NT,Alexander JH,Lopes RD

    更新日期:2014-08-01 00:00:00

  • A personal experience with 100 consecutive total colectomies and straight ileoanal endorectal pull-throughs for benign disease of the colon and rectum in children and adults.

    abstract::In 1974 total colectomy and ileoanal straight endorectal pull-through (ERPT) were first used at our institution for the definitive management of total colonic Hirschsprung's disease in infants and children. Early success with this operation encouraged us to use this procedure in children and adults with ulcerative col...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Coran AG

    更新日期:1990-09-01 00:00:00

  • Neutrophils dysfunction during the course of intra-abdominal infection.

    abstract::Twenty-four patients with intra-peritoneal infections were studied sequentially to evaluate neutrophil chemotaxis, spontaneous migration, and chemiluminescence. In six patients, infection was due to spontaneous disease processes and 18 others, infection was a sequel of intra-abdominal operation. In the patients studie...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Solomkin JS,Bauman MP,Nelson RD,Simmons RL

    更新日期:1981-07-01 00:00:00

  • Repeat hepatectomy for colorectal liver metastases.

    abstract:OBJECTIVE:The authors assess the long-term results of repeat hepatectomies for recurrent metastases of colorectal cancer and determine the factors that can predict survival. SUMMARY BACKGROUND DATA:Safer techniques of hepatic resection have allowed surgeons to consider repeat hepatectomy for colorectal metastases in a...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Adam R,Bismuth H,Castaing D,Waechter F,Navarro F,Abascal A,Majno P,Engerran L

    更新日期:1997-01-01 00:00:00

  • National Trends in Readmission Following Inpatient Surgery in the Hospital Readmissions Reduction Program Era.

    abstract:OBJECTIVE:The aim of this study was to investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions. SUMMARY BACKGROUND DATA:During the past decade, ther...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Mehtsun WT,Papanicolas I,Zheng J,Orav EJ,Lillemoe KD,Jha AK

    更新日期:2018-04-01 00:00:00

  • Open Versus Fenestrated Endovascular Repair of Complex Abdominal Aortic Aneurysms.

    abstract:OBJECTIVE:To compare outcomes of fenestrated (FEVAR) and open repairs of complex abdominal aortic aneurysms (cAAA). BACKGROUND:FEVAR has emerged as an alternative to open surgery for treating cAAA, but direct comparisons are limited. METHODS:We studied all repairs of intact or symptomatic cAAA in the Vascular Quality...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究


    authors: O'Donnell TFX,Boitano LT,Deery SE,Schermerhorn ML,Schanzer A,Beck AW,Green RM,Takayama H,Patel VI

    更新日期:2020-05-01 00:00:00

  • Multiple subcritical arterial stenoses: effect on poststenotic pressure and flow.

    abstract::Diminished poststenotic pressure and flow accompanied experimental application of multiple subcritical arterial stenoses in series. Effects of additional stenoses, causing equivalent constrictions, were cumulative in a nonlinear fashion. Seven-hundred-twenty measurements were performed using 10 cm ileofemoral canine a...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Flanigan DP,Tullis JP,Streeter VL,Whitehouse WM Jr,Fry WJ,Stanley JC

    更新日期:1977-11-01 00:00:00

  • Exclusion of nonisolated splenic vein in distal splenorenal shunt for prevention of portal malcirculation.

    abstract::In an attempt to prevent portoprival malcirculation after distal splenorenal shunt (DSRS), a splenic hilar renal shunt (HRS) with proximal flush ligation of splenic vein was designed. To accomplish this procedure, two methods were compared: HRS alone (Group A) and HRS plus proximal flush ligation of the splenic vein (...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Inokuchi K,Beppu K,Koyanagi N,Nagamine K,Hashizume M,Sugimachi K

    更新日期:1984-12-01 00:00:00

  • Altered gene transcription after burn injury results in depressed T-lymphocyte activation.

    abstract:OBJECTIVE:Patients with major burns and an animal model of burn injury were studied to determine the mechanism of depressed interleukin-2 (IL-2) production after thermal injury and to determine the effect of such injury on IL-2 receptor (IL-2R) expression and function. SUMMARY BACKGROUND DATA:Major burn injury is know...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Horgan AF,Mendez MV,O'Riordain DS,Holzheimer RG,Mannick JA,Rodrick ML

    更新日期:1994-09-01 00:00:00

  • A 4-tier Protocolized Radiological Classification System for Leaks Following Sleeve Gastrectomy.

    abstract:OBJECTIVES:To develop and validate a classification of sleeve gastrectomy leaks able to reliably predict outcomes, from protocolized computed tomography (CT) findings and readily available variables. SUMMARY OF BACKGROUND DATA:Leaks post sleeve gastrectomy remain morbid and resource-consuming. Incidence, treatments, a...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Johari Y,Catchlove W,Tse M,Shaw K,Paul E,Chen R,Loh D,Packiyanathan A,Burton P,Nottle P,Ellis S,Brown W

    更新日期:2021-01-19 00:00:00

  • Gastrin release by ethanol in man and in dogs.

    abstract::In man, oral or intravenous administration of ethanol caused a small but definite increase in peripheral serum gastrin concentration (measured by radioimmunoassay). In dogs, perfusion of the antrum with 10% ethanol caused an immediate increase in gastrin levels in the antral venous outflow. Acidification of the perfus...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Becker HD,Reeder DD,Thompson JC

    更新日期:1974-06-01 00:00:00

  • Factors influencing late survival after coronary bypass surgery.

    abstract::In order to determine which factors most influence late survival after the coronary bypass procedure, a review was made of the initial experience of one surgeon who performed 792 operations between 1968 and 1972. The initial 250 patients were compared with the subsequent 542 patients. The two groups were of similar ag...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Lawrie GM,Morris GC Jr

    更新日期:1978-06-01 00:00:00

  • Role of arteriography in rectal hemorrhage due to arteriovenous malformations and diverticulosis.

    abstract::Nine patients with arteriographic right colon arteriovenous malformations (AVM's) are reviewed. Even though five of the eight surviving patients had diverticulosis in remaining colon, right colectomy with removal of the AVM effectively controlled bleeding in seven of the eight patients in follow-up intervals of 14-66 ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Talman EA,Dixon DS,Gutierrez FE

    更新日期:1979-08-01 00:00:00

  • Operative management of rib fractures in the setting of flail chest: a systematic review and meta-analysis.

    abstract:OBJECTIVE:To perform a systematic review and meta-analysis of studies comparing operative to nonoperative therapy in adult FC patients. Outcomes were duration of mechanical ventilation (DMV), intensive care unit length of stay (ICULOS), hospital length of stay (HLOS), mortality, incidence of pneumonia, and tracheostomy...

    journal_title:Annals of surgery

    pub_type: 杂志文章,meta分析,评审


    authors: Leinicke JA,Elmore L,Freeman BD,Colditz GA

    更新日期:2013-12-01 00:00:00

  • Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria.

    abstract:INTRODUCTION:For patients with hepatocellular carcinoma (HCC) in particular, living donor liver transplant (LDLT) improves access to transplant. We report our results in 36 patients with HCC who underwent LDLT with a median follow-up >1 year. METHODS Underlying diagnoses included: hepatitis C (24), hepatitis B (9), cry...

    journal_title:Annals of surgery

    pub_type: 评论,杂志文章


    authors: Gondolesi GE,Roayaie S,Muñoz L,Kim-Schluger L,Schiano T,Fishbein TM,Emre S,Miller CM,Schwartz ME

    更新日期:2004-02-01 00:00:00

  • The spectrum and natural history of common bile duct stenosis in chronic alcohol-induced pancreatitis.

    abstract::Sixty patients with chronic alcohol-induced pancreatitis with endoscopic retrograde cholangiopancreatography evidence of common bile duct stenosis were studied to determine the clinical spectrum and natural history of this complication, as well as the indications for biliary bypass. In 17% of patients, common bile duc...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Kalvaria I,Bornman PC,Marks IN,Girdwood AH,Bank L,Kottler RE

    更新日期:1989-11-01 00:00:00

  • Treatment of symptomatic gastroesophageal reflux using the Angelchik prosthesis.

    abstract::During the past 20 months, 28 patients with symptomatic gastroesophageal reflux were treated with the Angelchik anti-reflux prosthesis. The patients ranged in age from 12 to 75 years, with symptoms present from one to 24 years. Vigorous medical management had failed with all patients prior to surgery. Before operation...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Starling JR,Reichelderfer MO,Pellett JR,Belzer FO

    更新日期:1982-06-01 00:00:00

  • Sentinel node staging of resectable colon cancer: results of a multicenter study.

    abstract:OBJECTIVE AND SUMMARY BACKGROUND DATA:Sentinel lymph node (LN) sampling, a technique widely used to manage breast cancer and melanoma, seeks to select LNs that accurately predict regional node status and can be extensively examined to identify nodal metastatic disease not detected by standard histopathological staging....

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章,多中心研究


    authors: Bertagnolli M,Miedema B,Redston M,Dowell J,Niedzwiecki D,Fleshman J,Bem J,Mayer R,Zinner M,Compton C

    更新日期:2004-10-01 00:00:00

  • Computed tomography in the diagnosis of intra-abdominal abscesses.

    abstract::The diagnosis of intra-abdominal abscess by radiographic means often relies on combining the results of several different imaging modalities. Computed tomography (CT) has been shown to be a safe, accurate and rapid diagnostic method of diagnosing these abscesses. Five patients with a variety of intra-abdominal abscess...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Daffner RH,Halber MD,Morgan CL,Trought WS,Thompson WM,Rice RP

    更新日期:1979-01-01 00:00:00

  • Increased CD4+ CD25+ T regulatory cell activity in trauma patients depresses protective Th1 immunity.

    abstract:OBJECTIVES:We recently reported increased CD4 CD25 T regulatory (Treg) activity after burn injury in mice. This study sought to determine if Tregs mediate the reduction in TH1-type immunity after serious injury in man and if Treg function is altered by injury. METHODS:Peripheral blood was withdrawn from 19 consenting ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: MacConmara MP,Maung AA,Fujimi S,McKenna AM,Delisle A,Lapchak PH,Rogers S,Lederer JA,Mannick JA

    更新日期:2006-10-01 00:00:00

  • Adequacy of margins of resection in gastrectomy for cancer.

    abstract::This study determines the infiltration rate of proximal and distal margins of resection in patients operated on for gastric cancer at the Istituto Nazionale Tumori of Milan. Two hundred and eighty-five proximal margins and 286 distal margins were reviewed, and the incidence of infiltration was related to the length of...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Bozzetti F,Bonfanti G,Bufalino R,Menotti V,Persano S,Andreola S,Doci R,Gennari L

    更新日期:1982-12-01 00:00:00

  • Impaired nonspecific cellular immunity in experimental cholestasis.

    abstract::The abilities of polymorphonuclear leukocytes (PMN) and pulmonary alveolar macrophages (PAM), to demonstrate chemotaxis, phagocytosis, and superoxide release after bile duct ligation in the rat were investigated to determine the effect of cholestasis on nonspecific cellular immune mechanisms. Chemotactic response to C...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Roughneen PT,Drath DB,Kulkarni AD,Rowlands BJ

    更新日期:1987-11-01 00:00:00

  • Lead poisoning from retained missiles. An experimental study.

    abstract::The problem of lead poisoning from bullets has been investigated by surgically implanting discs of lead, each enriched in a different natural isotope, into the tissue of two mongrel dogs and monitoring by mass spectrometry the release of the lead into each animal's blood over the course of 3 years. Lead placed in the ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Manton WI,Thal ER

    更新日期:1986-11-01 00:00:00

  • Assessing risk in liver transplantation. Special reference to the significance of a positive cytotoxic crossmatch.

    abstract:OBJECTIVE:The authors determined the impact of a positive cytotoxic crossmatch on the outcome of liver transplantation. SUMMARY BACKGROUND DATA:Liver allografts rarely undergo hyperacute rejection, but transplants performed across a positive cytotoxic crossmatch tend to follow a different clinical course, with higher ...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Doyle HR,Marino IR,Morelli F,Doria C,Aldrighetti L,McMichael J,Martell J,Gayowski T,Starzl TE

    更新日期:1996-08-01 00:00:00

  • Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients.

    abstract:OBJECTIVE:The aim of this study was to determine the results of liver resection for patients with bilateral hepatic metastases from colorectal cancer. We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome. SUMMARY BACKGROUND DATA:Although...

    journal_title:Annals of surgery

    pub_type: 杂志文章


    authors: Gold JS,Are C,Kornprat P,Jarnagin WR,Gönen M,Fong Y,DeMatteo RP,Blumgart LH,D'Angelica M

    更新日期:2008-01-01 00:00:00

  • Treatment of hyperesthetic neuropathic pain in diabetics. Decompression of the tarsal tunnel.

    abstract:OBJECTIVE:The authors evaluated the causal relationship between entrapment of the posterior tibial nerve and neuropathic pain and describe the results of nerve decompression in a selected group of patients with intractable pain. SUMMARY BACKGROUND DATA:Painful metabolic neuropathy has, until recently, been thought to ...

    journal_title:Annals of surgery

    pub_type: 临床试验,杂志文章


    authors: Wieman TJ,Patel VG

    更新日期:1995-06-01 00:00:00