Plain abdominal radiography in clinically suspected appendicitis: Diagnostic yield, resource use, and comparison with CT

• Published in: The American journal of emergency medicine 1999-07, Vol.17 (4), p.325-328
• Main Authors: Rao, Patrick M, Rhea, James T, Rao, Julie A, Conn, Alasdair K.T
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; appendicitis; Appendicitis - diagnostic imaging; Appendix; Biological and medical sciences; Child; Child, Preschool; Confidence Intervals; Costs and Cost Analysis; Diagnosis, Differential; Digestive system; Emergency Service, Hospital - organization & administration; Female; Hospital Costs; Humans; Infant; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; plain abdominal radiography; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography, Abdominal - economics; Radiography, Abdominal - statistics & numerical data; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed - economics; Tomography, X-Ray Computed - statistics & numerical data
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/S0735-6757(99)90077-3

This study determined the diagnostic utility and hospital resource impact of plain abdominal radiography in emergency department patients with suspected appendicitis. The authors reviewed medical records of 821 consecutive patients hospitalized for suspected appendicitis; 78% had plain abdominal radiography. Sixty-four percent had appendicitis. Radiographic findings were noted in 51% of patients with, and 47% of patients without appendicitis; no individual radiographic finding was sensitive or specific. Specific conditions were suggested in 10% of impressions; these failed to correlate with final clinical diagnoses 57% of the time. Hospital cost per abdominal radiograph was $67; cost per specific, correct radiographic diagnosis was $1,593. This is compared with $270 per appendiceal computed tomography scan (based on recent literature data). The authors conclude that plain abdominal radiographs in patients with suspected appendicitis are neither sensitive nor specific, are frequently misleading, are costly per specific and correct diagnosis, and should not be routinely obtained on patients with suspected appendicitis.