MDCT for suspected appendicitis in the elderly di

Authors: B Dustin Pooler Edward M Lawrence Perry J Pickhardt

Publish Date: 2011/12/01

Volume: 19, Issue: 1, Pages: 27-33

PDF Link

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 756 ± 75 years range 65–94 M/F 111151 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 168 44/262 CT sensitivity specificity PPV and NPV for acute appendicitis were 100 44/44 991 216/218 957 44/46 and 1000 216/216 respectively The negative appendectomy rate was 23 1/43 The perforation rate was 409 18/44 There were no falsenegative and two falsepositive CT interpretations All patients with appendicitis suspected on CT were hospitalized 44/44 with an average stay of 57 ± 32 days and 935 43/46 underwent appendectomy Overall surgical complication rate was 349 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  0003 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

Keywords: