Systematic Review: The Role of Intravenous and Oral Contrast in the Computed Tomography Evaluation of Acute Appendicitis

• Published in: The Journal of emergency medicine 2020-01, Vol.58 (1), p.162-166
• Main Authors: Soucy, Zachary, DO, Cheng, David, MD, Vilke, Gary M., MD, Childers, Richard, MD
• Format: Article
• Language: English
• Subjects: acute appendicitis; contrast; Emergency
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2019.10.034

AbstractBackgroundThis systematic review provides practicing emergency physicians updated information regarding the role of oral and intravenous contrast in the computed tomography (CT) evaluation of acute appendicitis. MethodsA PubMed literature search was conducted from January 1, 1996 to December 31, 2018 and limited to human clinical trials written in English with relevant keywords. High-quality studies were identified and then underwent a structured review. Recommendations are made based on the literature review. ResultsFifty-seven articles met criteria for rigorous review, of which 14 were appropriate for citation in this review. Excellent evidence shows that oral contrast does not improve the test characteristics of CT with intravenous contrast (IVCT) in the evaluation of adults suspected of having acute appendicitis. Good evidence shows that noncontrast abdominal CTs have excellent test characteristics for this same group of patients. ConclusionsConsidering its downsides and lack of utility, the medical literature does not support using oral contrast in the evaluation of acute appendicitis. There is no direct evidence showing that IVCT is better than a noncontrast CT in the evaluation of acute appendicitis; however, the available literature is consistent with slightly better test characteristics for IVCTs. Still, if IVCT cannot be obtained in a timely manner, noncontrast CTs are extremely accurate in detecting this disease.