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

Abstract:

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.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

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.

doi

10.1097/SLA.0000000000000272

subject

Has Abstract

pub_date

2014-08-01 00:00:00

pages

311-6

issue

2

eissn

0003-4932

issn

1528-1140

journal_volume

260

pub_type

杂志文章,多中心研究
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    journal_title:Annals of surgery

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

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

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  • Gastric surgery for morbid obesity. The Adelaide Study.

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    doi:10.1097/00000658-198107000-00003

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  • Repeat hepatectomy for colorectal liver metastases.

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    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199701000-00006

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    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

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    journal_title:Annals of surgery

    pub_type: 杂志文章

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    更新日期:1977-11-01 00:00:00

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    更新日期:1974-06-01 00:00:00

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    pub_type: 杂志文章

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    journal_title:Annals of surgery

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    pub_type: 杂志文章,meta分析,评审

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    pub_type: 评论,杂志文章

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    更新日期:1989-11-01 00:00:00

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    pub_type: 临床试验,杂志文章,多中心研究

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