In The Name of ALLAH, The Most Gracious The Most Merciful

“IMPACT OF CT-FACT ON
NEGATIVE
APPENDECTOMY RATES: DR. SYED SAAD AHMED
RESIDENT RADIOLOGY
PROSPECTIVE PGY-2

EVALUATION FROM A ZIAUDDIN UNIVERSITY HOSPITAL

TERTIARY CARE
HOSPITAL
 Background
• Appendicitis is one of the most common surgical abdominal
condition and appendectomy is one of the commonest emergency
procedures performed globally .
 Background
• It is the most common cause of acute abdomen in all age groups
where 10% of general population develops acute appendicitis with
highest incidence in second and third decades of life
 Background
• Delayed diagnosis of acute appendicitis and treatment has
adverse outcomes, like perforation which can lead to death.
 Background
• There are also high rates of negative appendectomies (NA), that
is appendectomies in patients with false diagnosis of appendicitis
 Background
• Negative appendectomies have constantly posed great burden
on the health care with complications like incisional hernia,
intestinal obstruction secondary to adhesion, and stump leakage,
leading to greater morbidity and mortality.
 Background
• The use of preoperative CT scan in diagnosis of acute
appendicitis can significantly reduce the burden of such
complications.
The Alvarado score and pediatric appendicitis score
are useful but not definitive.
Symptoms Migration of abdominal pain to the RLQ 1
Anorexia (or acetone in the urine) 1

Nausea/vomiting 1

Signs Tenderness in the RLQ 2

Rebound pain 1

Increase of temperature (≥37.3 °C) 1

Laboratory Leukocytosis (>10,000) 2

Shift to the left (in a differentiated WBC count) (eg, neutrophilia 1

>75%)

Cumulative score
5–6 compatible with acute appendicitis
7–8 probable for acute appendicitis
9–10 very probable for acute appendicitis.
OBJECTIVES
To determine and compare
the frequency of negative
appendectomy in cases of
acute appendicitis with and
without pre-op computed
tomography.
 METHODOLOGY
Study Design: Experimental study(Clinical trial)

Study Period: Six months (From July, 2016 to February , 2017)

Sample size: 116

Setting: Emergency Department, Departments of Radiology and

Surgery, Ziauddin University Hospital, Karachi

Data Collection: Electronic Data Retrieval System

PATIENTS WITH ALVARADO SCORE EQUALS TO
OR GREATER THAN WERE DIVIDED INTO

A B

Allowed and Did not allowed or

underwent CT underwent CT
 Individuals of
1 either gender, Having Alvarado
with age equal
2 score of 7 or more.
to or greater
than 18 years
and less than 60 INCLUSION
years,
presenting in the
CRITERIA
Emergency
department,
suspected of
acute
appendicitis.
 Incidental Pregnancy
1 appendectomy
2

EXCLUSION
CRITERIA
RESULTS
 RESULTS
Total number of patients 116
Total number of males 52
Total number of females 64
Total number of patients with CT 58
Total number of patients without CT 58
Total number of patients undergoing Surgery 114
Total number of patients with positive CT Scans 56
Negative appendectomies with CT scans 4
Negative appendectomies without CT scans 11
WITH CT SCANS
Results

7%

93%

Positive Negative
WITHOUT CT SCANS
Results

27%

73%

Positive Negative
CASES
Cases
 • Studies showed that abdominal CT
THE scans are relatively accurate and
increase correct diagnosis of acute
DISCUSSION appendicitis up to 95%. Moreover, there
is a possibility to increase correct
diagnosis to 98% when abdominal CT
scan is combined with physical
examination.
 • In one study the use of CT resulted in a
THE 50% decrease in the negative
appendectomy rate
DISCUSSION
• 11.4% with imaging

• 22.2% without preoperative scanning

 • An even more substantial reduction in the
THE negative appendectomy rate was observed
in a multicenter study
DISCUSSION
• 6.6% vs 20.6%

• which showed an inverse relationship

between negative appendectomy rate and
CT utilization
 • In our study, results showed that CT is
THE efficacious in deceasing negative
appendectomies with a marked difference
DISCUSSION in percentages

• 7.1 % with CT
• 19 % without CT

• making it investigation of choice in

suspected cases of appendicitis going for
surgery.
 CONCLUSION

“
The results show that CT in patients with suspected appendicitis leads to
lower negative appendectomy rates compared to ultrasound or clinical
examination alone . Therefore, preoperative imaging should be
considered a part of the routine evaluation for suspected cases of

”
appendicitis where CT also helps in excluding other causes of pelvic
pain.