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CT Scans For Appendicitis Take Huge Jump

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The use of CT scans to diagnose appendicitis has soared since the 1990s, according to a new study. What the study doesn’t address is whether that’s good or bad for patients.

The numbers are certainly dramatic. The study, published online August 1 in Annals of Emergency Medicine, analyzed a sample of 447,011 U.S. emergency department visits from 1992 through 2006, using National Hospital Ambulatory Medical Care Survey data.

The study found that from 1996 through 2006, the percentage of adult patients with appendicitis who received a CT scan increased from 6.3 percent to 69 percent. For children, the increase was from 0 percent to 59.8 percent.

Lead researcher Daniel S. Tsze, MD, is director of the pain management and sedation program at Morgan Stanley Children’s Hospital of New York-Presbyterian in New York. He told Reuters Health that the probable main reason for the huge increase was simple: CT is the most accurate test for appendicitis.

But is it overused? We don’t know, because we don’t know how the increase in scans correlates with patient outcomes. Because of the cost and the risk of radiation exposure, particularly for children, CT shouldn’t be used when patients’ symptoms very clearly point to appendicitis, Dr. Tsze said. Those patients should go straight to the operating room.

In less clearcut situations, CT can clearly help narrow down the diagnosis. Dr. Tsze said:

There are definitely situations where it’s indicated. But I don’t think it’s indicated in every case.

In some instances, he said, a thorough physical exam and a look at the patient’s medical history may be enough. Ultrasound can provide an alternative scan that’s free of radiation danger, but it’s not as accurate as CT. If an ultrasound were inconclusive, some patients would then get a CT scan anyway. Running two scans for a significant percentage of patients could get costly. And the patients, most of whom would be suffering considerable abdominal pain, wouldn’t appreciate the extra time it would take.

So we need some research on patient outcomes with and without CT. Right now, as Dr. Tsze put it, “With appendicitis, we just don’t know yet.”

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