Rao P M, Rhea J T, Novelline R A, Mostafavi A A, McCabe C J
Department of Radiology, Massachusetts General Hospital, Boston 02114, USA.
N Engl J Med. 1998 Jan 15;338(3):141-6. doi: 10.1056/NEJM199801153380301.
In patients with clinically suspected appendicitis, computed tomography (CT) is diagnostically accurate. However, the effect of routine CT of the appendix on the treatment of such patients and the use of hospital resources is unknown.
We performed appendiceal CT on 100 consecutive patients in the emergency department who, on the basis of history, physical examination, and laboratory results, were to be hospitalized for observation for suspected appendicitis or for urgent appendectomy. Outcomes were determined at surgery and by pathological examination in 59 patients, and by clinical follow-up two months later in 41 patients. Treatment plans made before CT were compared with the patients' actual treatment. We also determined the costs of surgery that revealed no appendicitis (from data on 61 patients), one day of observation in the hospital (from data on 350 patient-days in patients with suspected appendicitis), and appendiceal CT (from data on all pelvic CT examinations in 1996).
Fifty-three patients had appendicitis, and 47 did not. The interpretations of the appendiceal CT scans were 98 percent accurate. The results of CT led to changes in the treatment of 59 patients. These changes resulted in the prevention of unnecessary appendectomy in 13 patients, admission to the hospital for observation in 18 patients, admission to the hospital for observation before necessary appendectomy in 21 patients, and admission to the hospital for observation before the diagnosis of other conditions by CT in 11 patients. The effects of performing appendiceal CT on the use of hospital resources included the prevention of unnecessary appendectomy in 13 patients (for a savings of $47,281) and the prevention of unnecessary hospital admission for 50 patient-days (for a savings of $20,250). After the cost of 100 appendiceal CT studies ($22,800) was subtracted, the overall savings was $447 per patient.
Routine appendiceal CT performed in patients who present with suspected appendicitis improves patient care and reduces the use of hospital resources.
在临床怀疑患有阑尾炎的患者中，计算机断层扫描（CT）诊断准确率较高。然而，阑尾常规CT对此类患者治疗及医院资源利用的影响尚不清楚。
我们对急诊科连续100例患者进行了阑尾CT检查，这些患者基于病史、体格检查及实验室检查结果，因疑似阑尾炎需住院观察或紧急行阑尾切除术。59例患者通过手术及病理检查确定结局，41例患者在两个月后通过临床随访确定结局。将CT检查前制定的治疗计划与患者实际治疗情况进行比较。我们还确定了未发现阑尾炎的手术费用（来自61例患者的数据）、医院一天的观察费用（来自疑似阑尾炎患者350个患者日的数据）以及阑尾CT检查费用（来自1996年所有盆腔CT检查的数据）。
53例患者患有阑尾炎，47例未患阑尾炎。阑尾CT扫描的解读准确率为98%。CT结果导致59例患者的治疗发生改变。这些改变使得13例患者避免了不必要的阑尾切除术，18例患者住院观察，21例患者在必要的阑尾切除术前住院观察，11例患者在CT诊断出其他疾病前住院观察。进行阑尾CT对医院资源利用的影响包括13例患者避免了不必要的阑尾切除术（节省47,281美元）以及50个患者日避免了不必要的住院（节省20,250美元）。减去100次阑尾CT检查的费用（22,800美元）后，每位患者总体节省447美元。
对疑似阑尾炎患者进行常规阑尾CT检查可改善患者护理并减少医院资源的使用。
