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MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome

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Abstract

Elderly adults are at increased risk for complications related to both delayed diagnosis of appendicitis and to unnecessary appendectomy. We assessed the diagnostic performance of computed tomography (CT) in a consecutive elderly cohort with clinically suspected appendicitis. CT findings and clinical outcomes were analyzed for 262 consecutive adult patients age 65 and older (mean 75.6 ± 7.5 years; range 65–94; M/F 111:151) referred for clinically suspected appendicitis at a single medical center between January 2000 and December 2009. The overall prevalence of proven acute appendicitis in this elderly cohort with clinically suspected appendicitis was 16.8% (44/262). CT sensitivity, specificity, PPV, and NPV for acute appendicitis were 100% (44/44), 99.1% (216/218), 95.7% (44/46), and 100.0% (216/216), respectively. The negative appendectomy rate was 2.3% (1/43). The perforation rate was 40.9% (18/44). There were no false-negative and two false-positive CT interpretations. All patients with appendicitis suspected on CT were hospitalized (44/44), with an average stay of 5.7 ± 3.2 days, and 93.5% (43/46) underwent appendectomy. Overall surgical complication rate was 34.9% (15/43). Compared with younger adults over the same period, elderly patients had higher rates of perforation and surgical complications, and longer hospital stays (p < 0.003). CT is highly accurate for the evaluation of clinically suspected appendicitis in elderly patients. Prompt diagnosis is important given the higher rates perforation and surgical complications relative to younger adults.

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Authors and Affiliations

  1. Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA

    B. Dustin Pooler, Edward M. Lawrence & Perry J. Pickhardt

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  1. B. Dustin Pooler
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  2. Edward M. Lawrence
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  3. Perry J. Pickhardt
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Correspondence to Perry J. Pickhardt.

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Pooler, B.D., Lawrence, E.M. & Pickhardt, P.J. MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome. Emerg Radiol 19, 27–33 (2012). https://doi.org/10.1007/s10140-011-1002-3

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  • DOI: https://doi.org/10.1007/s10140-011-1002-3

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