Evaluation for suspected acute appendicitis in the emergency department setting: a comparison of outcomes among three imaging pathways ★

PurposeTo compare outcomes of imaging pathways in suspected acute appendicitis.MethodsComputerized tomography (CT) alone, ultrasound alone, and ultrasound followed by CT were compared in 570 emergency department (ED) patients with suspected acute appendicitis.ResultsAfter initial ultrasound, 9.3% of men and 41.0% of women underwent CT. Body mass index (BMI) (P ≤ .036): 25.3 ± 5.7 kg/m2 (CT), 19.1 ± 3.3 kg/m2 (ultrasound), and 22.4 ± 3.2 kg/m2 (ultrasound then CT). Age (P < .001): 35.9 ± 14.5 years (CT), 12.8 ± 6.2y (ultrasound), and 21.2 ± 9.0 years (ultrasound then CT). ED length-of-stay: 7.0 ± 2.8 h (CT), 5.9 ± 2.8 h (ultrasound), and 8.4 ± 3.5 h (ultrasound then CT). Admission, same-day discharge, appendectomy, pathology positive for appendicitis or complicated appendicitis, 30-day repeat ED visit/hospitalization: no difference between pathways (P = .062–1.00).ConclusionUltrasound, selected in patients with lowest age/BMI, had shortest length-of-stay but otherwise similar outcomes.