Enteral contrast in the computed tomography diagnosis of appendicitis comparative effectiveness in a prospective surgical cohort

Frederick Thurston Drake, Rafael Alfonso, Puneet Bhargava, Carlos Cuevas, Manjiri K. Dighe, Michael G. Florence, Morris G. Johnson, Gregory Jurkovich, Scott R. Steele, Rebecca Gaston Symons, Richard C. Thirlby, David R. Flum

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Objective: Our goal was to perform a comparative effectiveness study of intravenous (IV)-only versus IV + enteral contrast in computed tomographic (CT) scans performed for patients undergoing appendectomy across a diverse group of hospitals. Background: Small randomized trials from tertiary centers suggest that enteral contrast does not improve diagnostic performance of CT for suspected appendicitis, but generalizability has not been demonstrated. Eliminating enteral contrast may improve efficiency, patient comfort, and safety. Methods: We analyzed data for adult patients who underwent nonelective appendectomy at 56 hospitals over a 2-year period. Datawere obtained directly from patient charts by trained abstractors. Multivariate logistic regression was utilized to adjust for potential confounding. The main outcome measure was concordance between final radiology interpretation and final pathology report. Results: A total of 9047 adults underwent appendectomy and 8089 (89.4%) underwent CT, 54.1% of these with IV contrast only and 28.5% with IV + enteral contrast. Pathology findings correlated with radiographic findings in 90.0% of patients who received IV + enteral contrast and 90.4% of patients scanned with IV contrast alone. Hospitals were categorized as rural or urban and by their teaching status. Regardless of hospital type, there was no difference in concordance between IV-only and IV + enteral contrast. After adjusting for age, sex, comorbid conditions, weight, hospital type, and perforation, odds ratio of concordance for IV + enteral contrast versus IV contrast alone was 0.95 (95% CI: 0.72-1.25). Conclusions: Enteral contrast does not improve CT evaluation of appendicitis in patients undergoing appendectomy. These broadly generalizable results from a diverse group of hospitals suggest that enteral contrast can be eliminated in CT scans for suspected appendicitis.

Original languageEnglish (US)
Pages (from-to)311-316
Number of pages6
JournalAnnals of Surgery
Volume260
Issue number2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • Appendicitis
  • Comparative effectiveness
  • Computed tomography
  • Diagnosis
  • Enteral contrast
  • Oral contrast

ASJC Scopus subject areas

  • Surgery

Fingerprint Dive into the research topics of 'Enteral contrast in the computed tomography diagnosis of appendicitis comparative effectiveness in a prospective surgical cohort'. Together they form a unique fingerprint.

  • Cite this

    Drake, F. T., Alfonso, R., Bhargava, P., Cuevas, C., Dighe, M. K., Florence, M. G., Johnson, M. G., Jurkovich, G., Steele, S. R., Symons, R. G., Thirlby, R. C., & Flum, D. R. (2014). Enteral contrast in the computed tomography diagnosis of appendicitis comparative effectiveness in a prospective surgical cohort. Annals of Surgery, 260(2), 311-316. https://doi.org/10.1097/SLA.0000000000000272