Routine versus Selective Abdominal Computed Tomography Scan in the Evaluation of Right Lower Quadrant Pain: A Randomized Controlled Trial
2007; Wiley; Volume: 14; Issue: 2 Linguagem: Inglês
10.1111/j.1553-2712.2007.tb01754.x
ISSN1553-2712
AutoresChristopher C. Lee, Robert Golub, Adam J. Singer, Roberto Cantu, Howard Levinson,
Tópico(s)Hernia repair and management
ResumoAcademic Emergency MedicineVolume 14, Issue 2 p. 117-122 Free Access Routine versus Selective Abdominal Computed Tomography Scan in the Evaluation of Right Lower Quadrant Pain: A Randomized Controlled Trial Christopher C. Lee MD, Corresponding Author Christopher C. Lee MD Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY (Email: christolee@notes.cc.sunysb.edu).Search for more papers by this authorRobert Golub MD, Robert Golub MD Department of Surgery, Flushing Hospital Medical Center, Flushing, NYSearch for more papers by this authorAdam J. Singer MD, Adam J. Singer MD Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NYSearch for more papers by this authorRoberto Cantu Jr. MD, Roberto Cantu Jr. MD Department of Surgery, Flushing Hospital Medical Center, Flushing, NYSearch for more papers by this authorHoward Levinson MD, Howard Levinson MD Department of Surgery, Flushing Hospital Medical Center, Flushing, NYSearch for more papers by this author Christopher C. Lee MD, Corresponding Author Christopher C. Lee MD Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NY (Email: christolee@notes.cc.sunysb.edu).Search for more papers by this authorRobert Golub MD, Robert Golub MD Department of Surgery, Flushing Hospital Medical Center, Flushing, NYSearch for more papers by this authorAdam J. Singer MD, Adam J. Singer MD Department of Emergency Medicine, Stony Brook University Hospital, Stony Brook, NYSearch for more papers by this authorRoberto Cantu Jr. MD, Roberto Cantu Jr. MD Department of Surgery, Flushing Hospital Medical Center, Flushing, NYSearch for more papers by this authorHoward Levinson MD, Howard Levinson MD Department of Surgery, Flushing Hospital Medical Center, Flushing, NYSearch for more papers by this author First published: 28 June 2008 https://doi.org/10.1197/j.aem.2006.08.007Citations: 41AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Objectives To determine the role of abdominal computed tomography (CT) imaging in patients with right lower quadrant (RLQ) pain. The authors hypothesized that selective use of abdominal CT would reduce imaging without increasing the rates of negative appendectomy and perforated appendicitis. Methods A prospective randomized clinical trial was conducted in a community teaching emergency department. Adult patients with acute RLQ abdominal pain with suspected acute appendicitis were included. Patients were randomized to mandatory (all patients) or selective (based on clinical evaluation) abdominal CT imaging. The primary outcome was the negative appendectomy rate. Results A total of 152 patients were randomized to selective (n= 80) and mandatory (n= 72) intervention groups. The mean (±SD) age was 34.1 (±3.5) years, and 48% were female. CT imaging was performed in 54 of 80 patients (68%; 95% confidence interval [CI] = 56% to 78%) in the selective group and in 70 of 72 patients (97%; 95% CI = 90% to 100%) in the mandatory group. There was a trend to a decreased rate of negative appendectomy in the mandatory group (1/39 [2.6%]; 95% CI = 0.5% to 13.2%) as compared with the selective group (6/43 [13.9%]; 95% CI = 6.6% to 27.3%), with a difference in prevalence rates of 11.3% (95% CI =−3.5% to 26.3%). There was also a trend to a decreased perforated appendix rate in the mandatory group (4/39 [10.3%]) as compared with the selective group (7/38 [18.4%]), with a difference in prevalence rates of 8.2% (95% CI =−8.0% to 24.4%). Conclusions In this small sample of adult patients with RLQ abdominal pain and suspected acute appendicitis, CT imaging was performed less frequently in the selective group and there was a trend with mandatory CT imaging to reduced rates of negative appendectomy and perforated appendices. 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