Systematic Review: The Role of Intravenous and Oral Contrast in the Computed Tomography Evaluation of Acute Appendicitis
acute appendicitis; contrast; CT
BACKGROUND: This systematic review provides practicing emergency physicians updated information regarding the role of oral and intravenous contrast in the computed tomography (CT) evaluation of acute appendicitis. METHODS: A PubMed literature search was conducted from January 1, 1996 to December 31, 2018 and limited to human clinical trials written in English with relevant keywords. High-quality studies were identified and then underwent a structured review. Recommendations are made based on the literature review. RESULTS: Fifty-seven articles met criteria for rigorous review, of which 14 were appropriate for citation in this review. Excellent evidence shows that oral contrast does not improve the test characteristics of CT with intravenous contrast (IVCT) in the evaluation of adults suspected of having acute appendicitis. Good evidence shows that noncontrast abdominal CTs have excellent test characteristics for this same group of patients. CONCLUSIONS: Considering its downsides and lack of utility, the medical literature does not support using oral contrast in the evaluation of acute appendicitis. There is no direct evidence showing that IVCT is better than a noncontrast CT in the evaluation of acute appendicitis; however, the available literature is consistent with slightly better test characteristics for IVCTs. Still, if IVCT cannot be obtained in a timely manner, noncontrast CTs are extremely accurate in detecting this disease.
Soucy Zachary; Cheng David; Vilke Gary M; Childers Richard
The Journal of Emergency Medicine
2019
2019-12-13
Journal Article
<a href="http://doi.org/10.1016/j.jemermed.2019.10.034" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2019.10.034</a>
PMID: 31843324
The Use Of Abdominal Computed Tomography In Older Ed Patients With Acute Abdominal Pain
acute abdomen; acute appendicitis; age; diagnosis; diverticulitis; Emergency; Emergency Medicine; helical ct; impact; management; utility
The objectives of this study were to determine the prevalence of use of abdominal computed tomography (CT) in older ED patients with acute nontraumatic abdominal pain, describe the most common diagnostic CT findings, and determine the proportion of diagnostic CT results. This was a prospective, observational, multicenter study of 337 patients 60 years or older. History was obtained prospectively; charts were reviewed for radiographic findings, dispositions, diagnoses, and clinical course, and patients were followed up at 2 weeks for additional information. The prevalence of use of abdominal CT was 37%. The most common diagnostic findings were diverticulitis (18%), bowel obstruction (18%), nephrolithiasis (10%), and gallbladder disease (10%). Eight percent of patients had findings suggestive of neoplasm. Overall, 57% of CT results were diagnostic (95% confidence interval [CI], 49%-66%), 75% (95% CI, 63%-84%) for patients requiring acute medical or surgical intervention, and 85% (95% CI, 62%-97%) for patients requiring acute surgical intervention. CT use is highly prevalent in older ED patients with acute abdominal pain. CT results are often diagnostic, especially for patients with emergent conditions. (c) 2005 Elsevier Inc. All rights reserved.
Hustey F M; Meldon S W; Banet G A; Gerson L W; Blanda M; Lewis L M
American Journal of Emergency Medicine
2005
2005-05
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1016/j.ajem.2005.02.021" target="_blank" rel="noreferrer noopener">10.1016/j.ajem.2005.02.021</a>