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文献考察：急性虫垂炎の診断にCTを活用してnegative appendectomy rateが減少した．
１）Am Surg. 2003 Sep;69(9):727-31; discussion 731-2.
Liberal use of CT scanning helps to diagnose appendicitis in adults.
Brandt MM, Wahl WL.
Appendicitis can be difficult to diagnose as patients get older and the incidence of other intra-abdominal processes increases. We hypothesize that with the use of helical computed tomography (CT), we will be better at diagnosing appendicitis in adults. We reviewed all the medical records of patients 18 years and older who were admitted to our service with the diagnosis of appendicitis (ICD-9: 540.0, 540.1, 540.9, and 541) from January 1999 through October 2002. In addition to demographics, we collected pathology results, if CTs were done, and CT results. This study was approved by the Institutional Review Board (IRB) of the University of Michigan. Three hundred thirty patients with the diagnosis of appendicitis were admitted to our service. We found the negative appendectomy rate in all patients to be 12.1 per cent. In all patients who had CT scans, the negative appendectomy rate was 7.3 per cent. In patients > or = 45 years, patients without CT had 5.6 per cent negative appendectomy rate versus 5 per cent (P = 0.02) with CT scanning. There were no mortalities. Our negative appendectomy rate in adult patients is lower than previously published reports. We believe our high rate of CT scanning helped in making the correct diagnosis. We recommend liberal use of CT scanning to help diagnose appendicitis in adults. PMID: 14509318
２）J Surg Res. 2002 Jul;106(1):131-6.
Impact of abdominal CT imaging on the management of appendicitis: an update.
Fuchs JR, Schlamberg JS, Shortsleeve MJ, Schuler JG.
BACKGROUND: Abdominal computed tomographic scanning (ACTS) has recently been shown to be an accurate diagnostic tool for appendicitis and may improve the negative exploration rate in our patient population. MATERIALS AND METHODS: We reviewed 224 patients evaluated for appendicitis during 1998. Forty-two patients underwent appendectomy on clinical grounds alone (Group I), 182 patients underwent ACTS (Group II), and 79 patients in Group II were explored for appendicitis. Diagnostic errors, alternative diagnoses, and perforation rates were noted. RESULTS: There were five negative explorations in Group I (11.9%) and five in Group II (6.3%), resulting in a combined negative rate of 8.3%. The negative exploration rate in women was 23.5% in Group I and 5.3% in Group II (P = 0.07), producing a combined negative rate of 10.9%. Fifty-eight alternative diagnoses were made by ACTS. The ACTS made a critical difference in the management of 67% of patients over 50 years of age and in 79% of Group II patients. CONCLUSIONS: The negative exploration rate for appendicitis at our institution fell from 13.6 to 8.3% with selective use of ACTS. The most striking benefit occurred in women and in patients over 50 years of age. PMID: 12127818
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