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J Korean Soc Emerg Med > Volume 22(4); 2011 > Article
Journal of The Korean Society of Emergency Medicine 2011;22(4): 343-349.
Do Clinical Manifestations Influence the Efficiency of Computed Tomography and Ultrasonography in Diagnosing Acute Appendicitis?
Sung Bin Chon, Won Sup Oh, Seung Joon Lee, Yong Hwan Jeon, Chan Woo Park, Joong Bum Moon, Jun Hwi Cho
1Department of Emergency Medicine, Kangwon National University Hospital, Chuncheon, Korea.
2Department of Internal Medicine, School of Medicine Kangwon National University, Chuncheon, Korea.
3Department of Radiology, School of Medicine Kangwon National University, Chuncheon, Korea.
4Department of Emergency Medicine, School of Medicine Kangwon National University, Chuncheon, Korea. cjhemd@kangwon.ac.kr
Radiological readings of possible or suspicious appendicitis are often unhelpful for clinicians, and normal readings may be misleading if the patient has appendicitis. We conducted a retrospective study to determine whether the efficiency of computed tomography (CT) or ultrasonography (USG) in diagnosing acute appendicitis is altered by clinical manifestations.
Data were collected from all the pathologicallyproven acute appendicitis patients who underwent CT or USG and subsequently had appendectomy between January 2009 and March 2010 at Kangwon National University Hospital. We classified radiological findings of "compatible with" and "probable" appendicitis as "highly efficient" and "possible" or "suspicious" appendicitis and "normal appendix" as "less efficient." The following clinical manifestations were included: duration of the chief complaint prior to performing CT or USG, right lower quadrant pain, pain migration, body temperature, abdominal tenderness, rebound tenderness, muscle guarding, wall rigidity, white blood cell count, percentage of polymorphonuclear cells, and C-reactive protein level.
A total of 202 patients underwent appendectomies after imaging studies (37.2+/-20.3-years-of-age; male-to-female ratio, 1.08). Of these, 154(76.2%) received CT, 44 (21.8%) received USG, and four (2.0%) received magnetic resonance imaging. Radiological findings were highly efficient in 155 cases (76.7%) but less efficient in 47 cases (23.3%). Multiple logistic regression analysis demonstrated that the absence of pain migration was related to less efficient results (adjusted odds ratio, 3.26; 95% confidence interval, 1.16-9.12).
The 'efficient' sensitivity of CT or USG in diagnosing acute appendicitis is low in the absence of a history of pain migration.
Key words: Appendicitis, Computed tomography, Ultrasonography, Diagnosis, Efficiency
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