Department of Emergency Medicine, York Hospital, York, PA 17405, USA.
Am J Emerg Med. 2012 Nov;30(9):1765-73. doi: 10.1016/j.ajem.2012.02.011. Epub 2012 May 23.
When the diagnosis of appendicitis is uncertain, computerized tomography (CT) scans are frequently ordered. Oral contrast is often used but is time consuming and of questionable benefit. This study compared CT with intravenous contrast alone (IV) to CT with IV and oral contrast (IVO) in adult patients with suspected appendicitis.
This is a prospective, randomized study conducted in a community teaching emergency department (ED). Patients with suspected appendicitis were randomized to IV or IVO CT. Scans were read independently by 2 designated study radiologists blinded to the clinical outcome. Surgical pathology was used to confirm appendicitis in patients who went to the operating room (OR). Discharged patients were followed up via telephone. The primary outcome measure was the diagnosis of appendicitis. Secondary measures included time from triage to ED disposition and triage to OR.
Both IV (n = 114) and IVO (n = 113) scans had 100% sensitivity (95% confidence interval [CI], 89.3-100 and 87.4-100, respectively) and negative predictive value (95% CI, 93.7-100 and 93.9-100, respectively) for appendicitis. Specificity of IV and IVO scans was 98.6 and 94.9 (95% CI, 91.6-99.9 and 86.9-98.4, respectively), respectively, with positive predictive values of 97.6 and 89.5 (95% CI, 85.9-99.9 and 74.2-96.6). Median times to ED disposition and OR were 1 hour and 31 minutes (P < .0001) and 1 hour and 10 minutes (P = .089) faster for the IV group, respectively. Patients with negative IV scans were discharged nearly 2 hours faster (P = .001).
Computerized tomography scans with intravenous contrast alone have comparable diagnostic performance to IVO scans for appendicitis in adults. Patients receiving IV scans are discharged from the ED faster than those receiving IVO scans.
当阑尾炎的诊断不确定时，经常会进行计算机断层扫描（CT）检查。通常会使用口服造影剂，但既费时又疗效可疑。本研究比较了单纯静脉造影（IV）与 IV 和口服造影剂（IVO）联合 CT 在疑似阑尾炎的成年患者中的作用。
这是一项在社区教学急诊部（ED）进行的前瞻性、随机研究。将疑似阑尾炎的患者随机分为 IV 组或 IVO 组。2 名指定的研究放射科医生对扫描结果进行独立阅读，对临床结果不知情。对进入手术室（OR）的患者，手术病理用于确诊阑尾炎。通过电话对出院患者进行随访。主要结局指标为阑尾炎的诊断。次要指标包括从分诊到 ED 处置和分诊到 OR 的时间。
IV（n=114）和 IVO（n=113）扫描对阑尾炎的敏感性均为 100%（95%置信区间[CI]分别为 89.3%至 100%和 87.4%至 100%），阴性预测值均为 100%（95%CI 分别为 93.7%至 100%和 93.9%至 100%）。IV 和 IVO 扫描的特异性分别为 98.6%和 94.9%（95%CI 分别为 91.6%至 99.9%和 86.9%至 98.4%），阳性预测值分别为 97.6%和 89.5%（95%CI 分别为 85.9%至 99.9%和 74.2%至 96.6%）。IV 组患者分别在 ED 处置和 OR 的中位时间为 1 小时 31 分钟（P<.0001）和 1 小时 10 分钟（P=0.089）更快。接受 IV 扫描的患者的阴性扫描结果使他们提前近 2 小时出院（P=0.001）。
在成人阑尾炎的诊断中，单纯静脉造影 CT 扫描与 IVO 扫描具有相当的诊断性能。接受 IV 扫描的患者从 ED 出院速度比接受 IVO 扫描的患者快。
