The study group was composed of 821 patients admitted to hospital through
an Emergency Department for suspected appendicitis.(1)
male, 398 female patients ranging from 1 year to 89 years.
Of the 821 patients, 642 (78%) received an abdominal radiographic series
as part of their initial evaluation.
Radiographs on the 642 patients were interpreted without knowledge of
final clinical diagnosis, and a review of the reports was conducted
blinded to each patient's clinical diagnosis. Reports were reviewed
for findings, impressions related to appendicitis, and overall impressions.
Final diagnosis was either appendicitis, a specific alternate diagnosi,s
or nonspecific abdominal pain and was determined based on review of
charts for clinical diagnosis at discharge, not ascertained via surgery
and pathological examination. However, 524 (64%) patients had a diagnosis
of appendicitis confirmed by pathology.
(CI 44.2-54.3%) of patients with appendicitis had findings of some kind
on abdominal radiograph.
47% (CI 46.6 to 59.4%) of patients with diagnosis of appendicitis excluded
had findings on abdominal radiograph.
individual radiographic finding was statistically more likely to occur
in patients with appendicitis compared to those without.
radiographic impressions were normal 50 % of the time in patients with
appendicitis, and 60 % of the time in patients without (p=0.0075).
Radiographic impression suggested a diagnosis (appendicitis or other)
in 10% of the cases; failed to correlate 57 % of the time.
Average cost of a x-ray estimated at $67; average cost per correct diagnosis
was $1593 (642 X $ 67 divided by total number of correct and specific