Imaging in appendicitis: a review with special emphasis on the treatment of women

OBJECTIVE: Acute abdominal pain in women often presents the clinician with a diagnostic dilemma, especially if it is lower abdominal pain. Appendicitis is frequently entertained as a diagnosis, but until recently, the gold standard diagnostic procedure was operation, carrying a high false-negative rate. In recent years, computed tomographic (CT) scan has been advocated as a diagnostic aid. The purpose of this systematic review was to evaluate the accuracy of CT scan in diagnosing appendicitis. DATA SOURCES: Investigators searched PubMed between January and July 2003 using the terms "CT scan" and "appendicitis" with the limits "All adults 19+ years" and "English [language]." In addition, reference lists of all obtained articles were reviewed for other potential citations. METHODS OF STUDY SELECTION: All prospective studies of adults published in English were considered. TABULATION, INTEGRATION, AND RESULTS: Initial searches and reviews yielded 248 citations. Twenty-three of the citations reported prospective studies; only two of these were randomized studies. Prospective studies report sensitivities ranging from 77% to 100%, specificities ranging from 83% to 100%, and accuracies ranging from 88% to 98% for the diagnosis of acute appendicitis. Information gained from CT scans in patients with suspected appendicitis results in alternative diagnosis in 6% to 36%. These values are similar for both men and women. CONCLUSION: The data support routine use of CT scan in both men and women for the diagnosis of appendicitis.