@article {Lin149, author = {K-H Lin and W-S Leung and C-P Wang and W-K Chen}, title = {Cost analysis of management in acute appendicitis with CT scanning under a hospital global budgeting scheme}, volume = {25}, number = {3}, pages = {149--152}, year = {2008}, doi = {10.1136/emj.2007.050963}, publisher = {British Association for Accident and Emergency Medicine}, abstract = {Background: CT scanning of the abdomen is a highly accurate diagnostic tool for acute appendicitis. However, it is still relatively expensive in Taiwan, especially in hospitals which have adopted a global budgeting scheme. The purpose of this study was to analyse the cost of the management of this disease with and without CT scanning.Method: A retrospective observational study was undertaken from 1 January to 30 June 2005. Patients with a working diagnosis of {\textquotedblleft}acute appendicitis{\textquotedblright}, {\textquotedblleft}acute appendicitis should be ruled out{\textquotedblright} and {\textquotedblleft}differential diagnosis including acute appendicitis{\textquotedblright} were enrolled in the study. Patient demographic data, chief complaints, working diagnoses, laboratory data, CT reports, surgical findings and costs in the emergency department (ED) and ward were collected.Result: A total of 266 patients were admitted to an ED with symptoms suggesting acute appendicitis. Of these, 207 underwent an emergency appendectomy. An abdominal CT scan was performed in 71\% of patients with a diagnosis of {\textquotedblleft}differential diagnosis including acute appendicitis{\textquotedblright}, which was higher than in the other two diagnostic groups (18\% and 60\%). Patient age, high sensitivity C-reactive protein (hsCRP) concentration, ED stay, ED expenses and hospital stay were lower in the group that did not have a CT scan than in those who did. The net cost per patient with acute appendicitis in the group who underwent CT scanning was New Taiwan dollar (NT$)40 728, which was nearly equal to the net cost per patient in the group without CT scanning (NT$39 192).Conclusion: Routine CT scanning in patients with possible appendicitis is not necessary. History taking and physical examination combined with laboratory tests are still useful and cost-effective methods of diagnosing acute appendicitis.}, issn = {1472-0205}, URL = {https://emj.bmj.com/content/25/3/149}, eprint = {https://emj.bmj.com/content/25/3/149.full.pdf}, journal = {Emergency Medicine Journal} }