The Use of a Computed Tomography Scan to Rule Out Appendicitis in Women of Childbearing Age Is as Accurate as Clinical Examination: A Prospective Randomized Trial PETER P. LOPEZ, M.D., F.A.C.S.,* STEPHEN M. COHN, M.D.,* CHARLES A. POPKIN, M.D.,† JULIE JACKOWSKI, R.N.,† JOEL E. MICHALEK, PH.D.,* THE APPENDICITIS DIAGNOSTIC GROUP† From the *Department of Surgery, University of Texas Health Science Center, San Antonio, Texas and the †DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida Diagnosing appendicitis continues to be a difficult task for clinicians. The use of routine CT scan has been advocated to improve the accuracy of diagnosing appendicitis. When compared with the use of clinical examination alone, CT scan was not significantly different with regard to making the diagnosis of appendicitis in women of childbearing age. The use of computed tomography in making the diagnosis of appendicitis has become the current standard of practice in most emer- gency rooms. In women of childbearing age, with possible appendicitis, we prospectively com- pared clinical observation alone (OBS) to appendiceal CT scan with clinical observation (CT). Ninety women (OBS: 48, CT: 42) with questionable appendicitis and an Alvarado Score ranging from two to eight were prospectively randomized. A true positive study/exam resulted in a laparotomy that revealed a lesion requiring operation (confirmed by pathology). A true negative exam/study did not require operation. Hospital stay (OBS = 1.9 ± 1.6 vs CT = 1.3 ± 1.4 days) and charges (OBS = $9,459 ± 7,358 vs CT = $9,443 ± 8,773) were similar. The OBS group had an accuracy of 93 per cent, sensitivity of 100 per cent, and a specificity of 87.5 per cent. The CT group had an accuracy of 93 per cent, sensitivity of 89.5 per cent, and specificity of 95.6 per cent. Although this study is too small to statistically establish equivalence, the data suggest that a CT scan reliably identifies women who need an operation for appendicitis and seems to be as good as clinical examination. D IAGNOSING APPENDICITIS continues to be a difficult task for physicians. This is particularly true in women of childbearing age. Many female patients who are suspected of having appendicitis are found to have other conditions, such as pelvic inflammatory disease, acute cholecystitis, urinary tract infections, ovarian cysts, and gastroenteritis. 1 Not surprisingly, negative laparotomy rates for women of childbearing age are reported to be as high as 34 to 45 per cent. 2, 3 The utility of computed tomography (CT) as a di- agnostic examination for appendicitis has been de- scribed. 4–9 The literature reports a 93 to 98 per cent accuracy in diagnosing appendicitis. 4, 10–12 Rao et al. 12 suggested that an appendiceal CT scan should be routinely used in all patients because of the high ac- curacy and cost savings. Despite the growing enthusi- asm for routine CT, our group previously reported no added efficacy of CT use in a large prospective ran- domized trial in patients presenting to the emergency room with right lower quadrant pain comparing clini- cal assessment alone with clinical assessment and CT. 13 Because women of childbearing age may have pain related to other etiologies such as gynecological disorders, we felt that these patients might benefit from the use of routine CT to confirm or rule-out appendicitis. Therefore, we designed a prospective trial focusing on women of childbearing age to deter- For the Appendicitis Diagnostic Group: Margaret Brown, MSN, Fahim Habib, M.D., Jeffrey Augenstein, M.D., Erik Barquist, M.D., Patricia Byers, M.D., Carl I. Schulman, M.D., Enrique Ginzburg, M.D., Mauricio Lynn, M.D., Mark McKenney, M.D., Nicholas Namias, M.D., David Shatz, M.D., Danny Sleeman, M.D., S. Morad Hameed, M.D., Robb R. Whinney, D.O., Louis Pizano, M.D., Peter Ekeh, M.D., Suzanne LeBlang, M.D., and Martin Newman, M.D. Address correspondence and reprint requests to Peter P. Lopez, M.D., F.A.C.S., Assistant Professor of Surgery, Department of Surgery, University of Texas Health Science Center, 7703 Floyd Curl Drive, MC 7842, San Antonio, TX 78229. E-mail: Lopez@uthscsa.edu. 1232