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

https://doi.org/10.1016/S0735-6757(99)90077-3Get rights and content

Abstract

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.

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    Citation Excerpt :

    Plain films are seldom used in the diagnosis of appendicitis; however, they can help rule out other causes of abdominal pain (volvulus, intussusception, or nephrolithiasis) and may be performed rapidly at the bedside. Signs suggestive of appendicitis on radiograph include localized paralytic ileus, gas or fecalith in the appendix, blurring in the area of the right psoas muscle, and free air, although no sign is sensitive or specific in making the diagnosis,30 which limits the value of plain film in this disease. Ultrasound can be a useful test in the evaluation of appendicitis, particularly in children and pregnant women in whom there are particular concerns regarding ionizing radiation.

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No grant or other financial support was used for this investigation.

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