Low-Dose Abdominal CT for Evaluating Suspected Appendicitis
Kim K, Kim YH, Kim SY, et al
N Engl J Med. 2012;366:1596-1605
Summary
Does CT with low-dose radiation diagnose appendicitis as accurately as traditional high-radiation CT? In this single institution study from Korea, the authors randomly assigned 444 patients with suspected appendicitis to undergo low-dose CT and 447 patients to undergo standard-dose CT.
The main finding was that both groups had similar negative appendectomy rates: 3.5% vs 3.2% for the low- and high-dose groups, respectively, yielding a risk ratio of 1.08 (95% confidence interval, 0.37-3.13). No differences in perforation rates, time to appendectomy, or length of stay were found.
Viewpoint
CT is the main preoperative diagnostic test performed to determine the presence or absence of appendicitis. However, clinicians have been concerned about the possible radiation-related tumor risk in patients receiving CT, especially children. It is reassuring to learn that CT with a radiation dose that is only about 20% of the standard dose is equally effective in confirming the presence of acute appendicitis.
The radiologists who interpreted the scans came from a single tertiary care hospital. It is unknown what the results would be in smaller hospitals, where radiologists might have less experience with this modality.
Abstract