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Am J Surg. 2013 Apr;205(4):452-6. doi: 10.1016/j.amjsurg.2012.07.038. Epub 2013 Feb 4.

Examining the relevance of the physician's clinical assessment and the reliance on computed tomography in diagnosing acute appendicitis.

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Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA 98431, USA.



The aim of this study was to examine the relevance of clinical assessment in diagnosing appendicitis in the current medical environment, in which routine use of computed tomography (CT) has become the norm.


A retrospective review was conducted, analyzing patient demographics, Alvarado clinical assessment scoring, and radiologic and pathologic results.


A total of 664 patients were identified. Higher Alvarado scores were significantly associated with pathologically confirmed appendicitis (low, 87%; moderate, 92%; high, 96%; P = .05). As clinical assessment scores increased, use of CT decreased significantly (low, 97%; moderate, 85%; high, 79%; P = .01). The negative appendectomy rate for patients with clinical assessments consistent with appendicitis was 4%, compared with 3% associated with CT. Regardless of assessment scores, 82% of the cohort underwent CT. From a random sample of 100 charts, 87% of initial emergency department plans stratified disposition on the basis of the results of CT.


Although physical examination remains crucial, CT has become the primary modality dictating care of patients with presumed appendicitis.

[Indexed for MEDLINE]

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